The Efficacy Of Liraglutide And Dapagliflozin In T2DM Early Diabetic Nephropathy

Objective:The clinical efficacy was evaluated by observing the changes of clinical indexes in patients with early type 2 diabetic nephropathy before and after treatment with conventional hypoglycemic drugs combined with liraglutide or dapagliflozin.Furthermore,the therapeutic effects of the two drugs were further compared to provide a new idea for the treatment of the patients with diabetic kidney disease.Methods:In this study,120 patients with early type 2 diabetic nephropathy who met the inclusion criteria were selected had been admitted to the Department of Endocrinology of Changsha Fourth Hospital from January2020 to November 2020.According to the visiting order,the patients were completely randomized into conventional group,liraglutide group,dapagliflozin group and combined group,with 30 patients in each group.All patients continued with the previous routine hypoglycemic regimen(single or combined use of drugs were not restricted,except for DPP-4 inhibitors),and the conventional group did not need to adjust the regimen;liraglutide group: liraglutide was added(average dose was1.2mg daily);dapagliflozin group: dapagliflozin was added(average dose was 10 mg daily);combined group: liraglutide and dapagliflozin were added simultaneously(the average dose of both drugs was the same as that of the liraglutide group and dapagliflozin group).At the same time,all patients were given dietary guidance and appropriate exercise intervention for 12 weeks.The changes of blood glucose indexes,blood lipid indexes,body weight,body mass index(BMI),blood pressure,urinary albumin/creatinine ratio(UACR),uric acid(UA)and estimated glomerular filtration rate(e GFR)were compared before and after treatment,and the adverse effects occurred during treatment were recorded.Results:1.Before treatment,there was no statistical significance in the general data(age,sex ratio,course of disease,underlying disease,number of patients taking ACEI/ARB and lipid-lowering drugs)and various indicators(FPG,2h PG,Hb A1 c,body weight,BMI,SBP,DBP,TG,TC,LDL-C,HDL-C,UA,e GFR,UACR)of four groups(P > 0.05).2.Compared with before treatment,2h PG and Hb A1 c in the conventional group decreased(P < 0.05),while FPG,body weight,BMI,SBP,DBP,TG,TC,LDL-C,HDL-C,UA,e GFR and UACR had no significant changes(P > 0.05).In the liraglutide group,dapagliflozin group and the combined group,the level of SBP,DBP,e GFR,HDL-C has no obvious change,there was no statistically significant difference(P > 0.05),while the level of FPG,2h PG,Hb A1 c,weight,BMI,TG,TC,LDL-C,UACR in these three groups were obviously decreased(P <0.05),and the decrease of the above indexes in these three groups was more obvious than that in the conventional group(P < 0.05).3.Compared with before treatment,UA in the dapagliflozin group and combined group was significantly decreased(P < 0.05),and the difference was statistically significant compared with the conventional group(P < 0.05).4.After treatment,body weight,BMI and UACR of patients in the combined group decreased significantly compared with those in the liraglutide group and dapagliflozin group(P< 0.05),but there was no statistical significance in body weight,BMI and UACR between the liraglutide group and the dapagliflozin group(P > 0.05).5.During the treatment,1 patient in the conventional group and 1patient in the liraglutide group showed symptoms of hypoglycemia,which were improved after adjusting the hypoglycemic treatment regimen and strengthening diet education.Gastrointestinal reactions occurred in10 patients in the liraglutide group and 13 patients in the combined group within the first week of treatment,which were gradually tolerated.There were no adverse effects,such as hypotension,urinary tract or reproductive tract infection,diabetic ketoacidosis,drug allergy,etc.,and no death cases were found.Conclusion:In early diabetic nephropathy patients,on the basis of conventional hypoglycemic drug treatment,the addition of either liraglutide or dapagliflozin can not only make the blood glucose reach the standard safe and faster,but also play a role in regulating blood lipid and reducing proteinuria.If the combination of liraglutide and dapagliflozin can be used at the same time,it has been found that there is a tendency to further reduce early proteinuria in diabetic nephropathy patients.