The Clinic Observation Of Exenatide Therapy For Patients With Earlier Type 2 Diabetic Nephropathy

Objective To observe the changes of blood sugar,blood pressure,body mass index,blood lipid and kidney related indicators in patients with early type 2 diabetic nephropathy treated with exenatide.Methods Ninety patients with early type 2 diabetic nephropathy diagnosed in the Second Affiliated Hospital of Anhui Medical University from September 2016 to March 2018 were randomly divided into exenatide group and control group,45 cases in each group.The control group was treated with insulin glargine on the original hypoglycemic regimen,while the exenatide group was treated with exenatide.The fasting blood glucose(FBG)and postprandial 2h blood glucose(2h PG),glycosylated hemoglobin(HbA1c),systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI),low density lipoprotein cholesterol(LDL-C),triglycerides(TG),total cholesterol(TC),serum creatinine(Scr),the ratio of urinary albumin to creatinine(UACR),serum cystatin C(CysC)and urinary N-acetyl-beta-D Glucosaminidase(NAG)were respectively measured before treatment and after 20 weeks of treatment.Results Blood sugar: After 20 weeks of treatment,HbA1 c decreased from(8.72 ±1.20)to(7.21±0.57),FBG decreased from(9.44 ± 1.11)to(6.91 ± 0.54),and 2hPG decreased from(15.51±1.23)to(9.08 ± 0.83)(P<0.05),There was no significant difference in the decrease of HbA1 c between the exenatide group and the control group(P>0.05),but the level of 2h PG in the exenatide group improved more significantly than that in the control group(P<0.05).Body mass index :BMI in the exenatide group decreased from(28.64±3.37)to(26.78±2.59)(P<0.05),while BMI in the control group increased from(28.39±2.45)to(29.55±2.53)(P<0.05).blood lipids:total cholesterol decreased from(5.64±0.76)to(4.28±0.72),triglyceride decreased from(3.09±0.92)to(2.48±0.62)and low density lipoprotein cholesterol decreased from(3.19±0.56)to(2.71±0.57)in the exenatide group,all of which were improved compared with those before treatment(P< 0.05),and the decrease was more significant than that in the control group(P< 0.05).Blood pressure: There was no significant change in systolic blood pressure and diastolic blood pressure before and after treatment in the control group(P>0.05).The systolic blood pressure(SBP)decreased from(134.80±11.33)to(130.20±10.07)and diastolic blood pressure(DBP)decreased from(85.80±6.33)to(84.01±5.77)。all of which were improved compared with those before treatment(P<0.05).kidney related indicators: UACR in exenatide group decreased from(94.09±10.51)to(50.45±11.06),and UACR in control group decreased from(93.07±8.59)to(82.12±10.72).UACR of exenatide decreased more significantly than that of control group(P<0.05).There was no significant difference in serum Scr between exenatide group and control group before and after treatment(P>0.05).The serum CysC and urinary NAG in the exenatide group decreased from(1.96±0.47)to(1.30±0.26)and from(30.55±7.19)to(21.24±8.24)(P<0.05).There were no significant changes in serum CysC and NAG in the control group before and after treatment(P>0.05).Conclusions Exenatide can delay the progress of diabetic nephropathy by controlling blood sugar,blood pressure,reducing body weight,improving blood lipid disorder and reducing urinary protein excretion in patients with early type 2 diabetic nephropathy.