Effects Of Enterocatine Analogues On Cardiac Function In Patients With Type 2 Diabetes Mellitus Complicated With Coronary Heart Disease

Objective:Diabetes mellitus(DM)is a group of endocrine and metabolic syndrome caused by a combination of genetic and environmental factors.Because of its high incidence,many complications and high disability,it has become a serious threat to human health and life worldwide public health problems.As the most common type of diabetes,type 2 diabetes mellitus(T2DM)accounts for 90%-95% of the total population.Coronary heart disease(CHD)is the most common cardiovascular complication of T2 DM.It is the result of macroangiopathy and microangiopathy caused by hyperglycemia toxicity.It is also one of the main causes of death.Glucagon-like peptide-1 receptor agonist(GLP-1RA)is one of the main intestinal pancreatin analogues.It has been widely accepted by many clinicians and patients because of its multiple traditional effects such as safe hypoglycemia,improving blood lipids,inhibiting appetite and weight loss.In recent years,a large number of basic and clinical trials on GLP-1RA have shifted their research targets to its cardiovascular protection,and found gratifying clinical value.This study was to investigate the effects of glucagon-like peptide-1 receptor agonists on cardiac function in patients with type 2 diabetes mellitus and coronary heart disease.Methods:Ninety-six patients with coronary heart disease(CHD)complicated by T2 DM who were treated with premixed insulin(INS)combined with oral hypoglycemic drugs in our hospital from October 1,2016 to April 1,2018 were collected,including 49 males and 47 females.They were randomly divided into two groups: insulin(INS)group(control group)and GLP-1RA group(experimental group).In GLP-1RA group,liraglutide was injected subcutaneously before breakfast.The initial dose was 0.6 mg/d,increased to 1.2 mg/d after one week and adjusted to 1.8 mg/d after two weeks.The maximum dose of liraglutide was not more than 1.8 mg/d.INS group was converted into intensive insulin hypoglycemic regimen according to the dosage of premixed insulin.During the experiment,blood sugar was monitored strictly in both groups,and the dose of the original hypoglycemic program was gradually reduced according to the monitoring results,so that blood sugar could reach the standard.Professionals guide diet and exercise,blood glucose monitoring methods,the correct use of liraglutide and insulin,adverse reaction records and treatment,etc.The total course of treatment is 26 weeks.The body weight,waist circumference(WC),systolic blood pressure(SBP),fasting venous blood glucose(FPG),fasting insulin(FINS),postprandial 2H blood glucose(PPG),glycosylated hemoglobin(Hb A1c),triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),heart rate(HR)were recorded before and after treatment.left ventricular ejection fraction(LVEF),brain natriuretic peptide(NT-pro BNP),carotid intima-media thickness(CIMT),high sensitivity c-reactive protein(hs-CRP)and 24-hour urinary sodium were measured.body mass index(BMI)and insulin resistance index(HOMA-IR)were calculated.Incidence of adverse events = number of adverse reactions / total cases * 100%.Statistical analysis was performed on all recorded values.Results:(1)After 26 weeks of treatment,FBG,PPG,Hb Alc,HOMA-IR,TG,TC,LDL-C,hs-CRP in the two groups were all decreased(P < 0.05),and the experimental group was lower than the control group(P < 0.05),with statistical significance.(2)WC,BMI and SBP in GLP-1RA group decreased significantly after treatment(P < 0.05);but WC and BMI in INS group did not change significantly compared with before treatment,and SBP decreased significantly(P < 0.05).(3)Compared with before treatment,HR and LVEF in GLP-1RA group increased significantly after treatment(P < 0.05);CIMT decreased,P < 0.05,with statistical significance;NT-pro BNP and 24-hour sodium in urine did not change significantly(P > 0.05);while in INS group,LVEF increased,P < 0.05,with statistical significance,while HR,CIMT,NT-pro BNP,24-hour sodium in urine had no significant difference compared with before treatment.(4)The adverse events recorded during the course of treatment were mild to moderate,and there were no serious adverse reactions.There were 8 cases of hypoglycemia,2 cases in the experimental group,the incidence of hypoglycemia was 4.2%(2/48),which was significantly lower than 12.5%(6/48)in the control group.Adverse digestive tract events occurred only after liraglutide treatment,and occurred at the 4th week of treatment,including nausea in 10 cases(20.8%),vomiting in 5 cases(10.4%),diarrhea in 1 case(2.1%)and abdominal distention in 2 cases(4.2%).Conclusion:The application of GLP-1 receptor agonists in patients with type 2 diabetes mellitus complicated with coronary heart disease can improve cardiac function by controlling blood sugar,reducing body weight,regulating blood lipid profile,diastolic blood pressure,improving insulin resistance,biological factors for reducing cardiovascular risk,increasing left ventricular systolic fraction and anti-atherosclerosis,so as to benefit patients from cardiovascular disease.