Real-world Study Of Dulaglutide In The Treatment Of Type 2 Diabetes Mellitus Combined With Non-alcoholic Fatty Liver Disease

Background Type 2 diabetes mellitus（T₂DM）combined with non-alcoholic fatty liver disease（NAFLD）has a high incidence and negative influence.There are still no drugs approved for the treatment of T₂DM with NAFLD,so it is important to explore effective and safe drug treatment options.Objective To observe and analyse the effects of dulaglutide on the severity of fatty liver and on blood glucose,body weight,lipids and liver function in patients with T₂DM combined with NAFLD,to assess the efficacy of dulaglutide in NAFLD and the safety of the drug,and to provide strong evidence for clinical treatment.Methods In this retrospective study,patients with T₂DM combined with NAFLD treated at the Department of Endocrinology,Yichang Central People’s Hospital from October 2020 to November 2022 were selected,and the population was screened according to the inclusion and exclusion criteria,and 229 study subjects were finally included.We compared the changes in the severity of fatty liver before and after≥6 months of treatment with dulaglutide,as well as the changes in body weight,body mass index（BMI）,fasting plasma glucose（FPG）,glycosylated hemoglobin（Hb A1c）,triacylglyceride（TG）,total cholesterol（TC）,low density lipoprotein cholesterin（LDL-cholesterin）,and low density lipoprotein cholesterol（LDL-CC）.triglyceride（TG）,total cholesterol（TC）,low density lipoprotein cholesterin（LDL-C）,high density lipoprotein cholesterol（HDL-C）cholesterol（HDL-C）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,and to observe the incidence of adverse reactions.Results（1）Changes of severity of fatty liver after treatment:30 cases（13.10%）were cured,among which 23 cases（10.04%）were mildly transformed into normal,5 cases（2.18%）were moderately transformed into normal,and 2 cases（0.87%）were severely transformed into normal.64 cases（27.95%）were improved,among which 42 cases（18.34%）were moderately transformed into mild,18 cases（7.86%）were severely transformed into moderate,and 4 cases（1.75%）were severely transformed into mild.There were 135 cases（58.95%）with no progression,of which 91 cases（39.74%）were mild,30 cases（13.10%）were moderate,and 14 cases（6.11%）were severe.0 cases（0%）progressed.（2）FPG and Hb A1c were significantly decreased after treatment,with a statistically significant difference compared to pre-treatment（P<0.05）.（3）BMI and body weight were both significantly decreased after treatment,and the difference was statistically significant compared with that before treatment（P<0.05）.（4）LDL-C,CHOL and TG were all significantly decreased after treatment,and the difference was statistically significant compared with that before treatment（P<0.05）.There was no significant difference in HDL-C level after treatment（P>0.05）.（5）AST and ALT were significantly decreased after treatment,and the difference was statistically significant compared with that before treatment（P<0.05）.（6）Hypoglycaemia occurred in 2 cases（0.87%）,nausea in 8 cases（3.49%）,vomiting in 4 cases（1.75%）and diarrhoea in 6 cases（2.62%）during treatment.No acute pancreatitis,increased heart rate,First degree atrioventricular block/prolonged PR interval or allergic reactions were observed in any of the patients.Conclusion（1）In patients with T₂DM combined with NAFLD,the use of dulaglutide can delay,prevent or even reverse the progression of NAFLD.（2）In patients with T₂DM combined with NAFLD,the use of dulaglutide not only improves blood glucose,but also reduces body weight and improves blood lipids and liver function.（3）Dulaglutide is safe in the treatment of T₂DM patients with NAFLD.