| Objective: To investigate the intervention effects of GLP-1RA liraglutide and conventional hypoglycemic therapy on blood glucose,blood lipids,islet function,body weight,BMI and other biochemical and metabolic indicators,inflammatory cytokines interleukin-6（IL-6）and leptin（LEP）as well as AHI and other respiratory indicators of type 2 diabetes mellitus（T2DM）patients with obstructive sleep apnea hypopnea syndrome（OSAHS）.And to discuss the interaction and correlation mechanism of T2 DM and OSAHS,the effect of liraglutide combined with conventional hypoglycemic therapy on patients with type 2 diabetes complicated with OSAHS,and the therapeutic options for complications.Methods: A total of 98 patients with type 2 diabetes complicated with OSAHS who were hospitalized in the Department of Endocrinology of the First Affiliated Hospital of Dali University from May 2020 to June 2021 were selected.They were divided into two groups by random number table method,47 cases in the experimental group（liraglutide intervention group）and 51 cases in the control group（conventional hypoglycemic treatment group）.The experimental group was combined with liraglutide on the basis of conventional hypoglycemic treatment.Liraglutide started from 0.6mg/day,and gradually increased by 1.2mg/ day and 1.8mg/ day according to the adverse reactions and the control of metabolic indicators such as blood glucose.General clinical data of all enrolled patients were observed and recorded,as well as biological and metabolic indicators such as body weight,BMI,fasting blood glucose（FPG）,2-hour postprandial blood glucose（2h PG）,glycated hemoglobin（Hb A1c）,islet function,blood lipid（TC,TG,LDL-C,HDL-C）;IL-6,LEP;AHI,red blood cell count（RBC）,hemoglobin（HGB）,etc.All of these data in the above should be collected before and 6 months after treatment.SPSS 26.0 was used for statistical analysis of clinical data and laboratory data between and within the two groups before and after treatment,and P<0.05 was considered statistically significant.Results:1.Comparison of blood glucose indexes between the two groups before and after treatment: After treatment,in both the experimental group and the control group,FPG（P <0.001）and 2h PG（P <0.001）decreased significantly respectively.Hb A1c（P<0.001）decreased significantly in the experimental group,while there was no significant change in the control group compared with prior treatment.After treatment,2h PG and Hb A1 c in the experimental group were lower than those in the control group,and the difference was statistically significant（P <0.05）,while there was no significant difference in FPG.2.Fasting insulin（FINS）,fasting C-peptide（FC-P）and insulin resistance index（HOMA-IR）were compared between 2 groups before and after treatment:there were no statistical differences in FC-P,FINS and HOMA-IR between the two groups before treatment.After treatment,FC-P in the experimental group was higher than in the control group after treatment,with a statistically significant difference（P <0.05）,while FINS and HOMA-IR showed no significant differences between the two groups.3.Comparison of blood lipid between the two groups before and after treatment: The comparison in the experimental group before and after treatment shows,TC,TG and LDL decreased significantly（P <0.05）,but HDL had no significant difference.The comparison in the control group before and after treatment shows,TC and LDL decreased significantly（P <0.05）,HDL and TG had no significant difference.After treatment,there was no statistically significant difference in four blood lipid indexes between the two groups（P >0.05）.4.Comparison of BMI and weight varies between the 2 categories before and after treatment: Within 24 weeks of treatment,the weight and BMI of the experimental group and the control group both decreased,and the difference was statistically meaningful（P <0.05）,but the BMI of the 2 categories did not vary（P >0.05）.Further comparison of weight loss between the two groups revealed that the weight loss degree of the experimental group was greater than that of the control group,with statistical significance（P <0.05）.5.Comparison of the levels of inflammatory factors IL-6 and LEP between the two groups before and after treatment: the baseline IL-6 and LEP of the two groups were consistent before treatment（P>0.05）.There were significant variations in IL-6 and LEP levels between the two groups after treatment,with the experimental group significantly lower than the control group（P <0.05）.In the experimental group,IL-6level was significantly lower than before treatment（P <0.05）,while LEP levels almost remained unchanged;The levels of IL-6 and LEP in the control group showed no significant change compared with before treatment.6.Comparison of AHI,RBC and HGB levels between the two groups before and after treatment: The experimental group’s AHI,RBC,and HGB levels all dropped dramatically after therapy（P<0.05）.In the control group,there were no significant changes in the three indicators.There were no significant differences in the three indexes between the two groups after therapy.7.Comparison of changes in body weight,IL-6,LEP,AHI,RBC and HGB: Both the experimental and control groups lost weight after treatment compared to before treatment,and the experimental group lost more weight than the control group;the difference was statistically significant（P<0.05）.In the experimental group,IL-6,LEP,AHI,RBC and HGB were significantly decreased after treatment compared with before,and the significant decreases of IL-6 and AHI were greater than those in the control group（P<0.05）.In the control group,IL-6 showed an upward trend,which was significantly different from the improvement of inflammation in the experimental group.Although LEP increased,the overall change was not substantially different from the experimental group（P >0.05）.RBC and HGB revealed a declining trend,although the difference was not statistically significant（P >0.05）when compared to the experimental group.Conclusions: 1.Patients who suffered from T2 DM complicated with OSAHS may have metabolic disorders such as insulin resistance and leptin resistance under the condition of high levels of inflammation and leptin in their bodies.2.Liraglutide combined with conventional hypoglycemic therapy can significantly improve blood glucose level and islet function in patients with T2 DM complicated with OSAHS.3.Liraglutide combined with conventional hypoglycemic therapy can effectively regulate blood lipids of T2 DM complicated with OSAHS,especially in reducing TC and TG.4.Liraglutide combined with conventional hypoglycemic therapy can effectively reduce body weight.5.In patients with T2 DM complicated with OSAHS,liraglutide combined with conventional hypoglycemic regimen is beneficial to reduce AHI,blood viscosity and improve hypoxia;At the same time,it can improve the metabolic status of patients,reduce the levels of inflammatory factors and leptin.This may be related to the combined effects of weight loss,hypoglycemia and lipid regulation. |
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