Abstract:

Objective　To investigate the efficacy and safety of insulin glargine combined with semaglutide injection in the treatment of type 2 diabetes mellitus (T2DM) patients with poor blood glucose control and hypertension. Methods　One hundred and four T2DM patients with poor blood glucose control and hypertension treated at Jinan Maternal and Child Health Hospital from July 2021 to February 2023 were selected for the randomized controlled trial, and were divided into a control group and a study group by the random number table method, with 52 cases in each group. There were 30 males and 22 females in the control group; they were (48.04±4.03) years old; their body mass index was (24.08±3.15) kg/m²; their duration of T2DM was (5.96±0.74) years; their duration of hypertension was (2.96±0.41) years. There were 28 males and 24 females in the study group; they were (47.13±4.48) years old; their body mass index was (24.14±2.86) kg/m²; their duration of T2DM was (6.13±0.85) years; their duration of hypertension was (3.03±0.38) years. The control group were treated with semaglutide injection, and the study group with insulin glargine and semaglutide injection, for 3 months. The glucose metabolism, islet function, lipid metabolism, and blood pressures before and after the treatment and incidences of adverse drug reactions were compared between the two groups by t and χ² tests. Results　The levels of fasting blood glucose (FBG), 2 h postprandial blood glucose (2hPBG), and glycosylated hemoglobin (HbA1c) and insulin resistance index (HOMA-IR) were lower after than before the treatment in both groups; the levels of FPG, 2hPPG, and HbA1c and HOMA-IR after the treatment in the study group were lower than those in the control group [(5.91±0.76) mmol/L vs. (6.49±0.88) mmol/L, (8.47±0.96) mmol/L vs. (9.58±1.06) mmol/L, (5.27±0.73)% vs. (6.19±0.97)%, and (4.53±0.69) vs. (5.39±0.86); t=3.935, 5.774, 9.724, and 5.624; all P<0.05]. The levels of triglyceride (TG) and total cholesterol (TC) were lower after than before the treatment in both groups; the levels of TG and TC after the treatment in the study group were lower than those in the control group [(2.11±0.31) mmol/L vs. (2.49±0.39) mmol/L and (4.74±0.58) mmol/L vs. (5.29±0.75) mmol/L; t=5.500 and 4.183; both P<0.05]. The levels of low density lipoprotein cholesterol (LDL-C) in both groups after the treatment were lower than those before the treatment (both P<0.05); there was no statistical difference in the level of LDL-C after the treatment between the two groups (P>0.05). There were no statistical differences in the systolic and diastolic blood pressures after the treatment between the control group and the study group [(121.03±14.28) mmHg (1 mmHg=0.133 kPa) vs. (116.81±15.41) mmHg and (84.01±9.62) mmHg vs. (81.98±8.56) mmHg; both P>0.05]. There was no statistical difference in the incidence of adverse drug reactions between the control group and the study group [11.54% (6/52) vs. 13.46% (7/52); P>0.05]. Conclusion　Insulin glargine combined with semaglutide injection for T2DM patients with poor blood glucose control and hypertension can effectively control their glucose and lipid metabolism and improve their function of pancreatic islets, and is safe.

Key words:

Type 2 diabetes mellitus, Hypertension, Insulin glargine, Semaglutide

摘要：

目的　探讨甘精胰岛素联合司美格鲁肽注射液治疗血糖控制不佳的2型糖尿病（T2DM）合并高血压患者的效果及安全性。方法　选取济南市妇幼保健院2021年7月至2023年2月收治的104例血糖控制不佳的T2DM合并高血压患者进行随机对照试验，采用随机数字表法将其分为对照组、研究组，各52例。对照组男30例，女22例，年龄（48.04±4.03）岁，体质量指数（24.08±3.15）kg/m²，T2DM病程（5.96±0.74）年，高血压病程（2.96±0.41）年；研究组男28例，女24例，年龄（47.13±4.48）岁，体质量指数（24.14±2.86）kg/m²，T2DM病程（6.13±0.85）年，高血压病程（3.03±0.38）年。对照组采用司美格鲁肽注射液治疗，研究组采用甘精胰岛素联合司美格鲁肽注射液治疗，均治疗3个月。采用t检验及χ²检验对比两组治疗前后糖代谢情况、胰岛功能情况、脂代谢情况、血压情况、药物不良反应情况。结果　两组治疗后空腹血糖（fasting blood glucose，FBG）、餐后2 h血糖（2 h postprandial blood glucose，2hPBG）、糖化血红蛋白（glycosylated hemoglobin，HbA1c）、胰岛素抵抗指数（insulin resistance index，HOMA-IR）较治疗前均降低（均P<0.05），且研究组FBG、2hPBG、HbA1c、HOMA-IR均低于对照组［（5.91±0.76）mmol/L比（6.49±0.88）mmol/L、（8.47±0.96）mmol/L比（9.58±1.06）mmol/L、（5.27±0.73）%比（6.19±0.97）%、（4.53±0.69）比（5.39±0.86）；t=3.935、5.774 、9.724、5.624，均P<0.05］。两组治疗后三酰甘油（triglyceride，TG）、总胆固醇（total cholestero，TC）水平较治疗前均降低（均P<0.05），且研究组TG、TC水平低于对照组［（2.11±0.31）mmol/L比（2.49±0.39）mmol/L、（4.74±0.58）mmol/L比（5.29±0.75）mmol/L；t=5.500、4.183，均P<0.05］。两组治疗后低密度脂蛋白胆固醇（low density lipoprotein cholesterol，LDL-C）水平较治疗前均降低（均P<0.05），但两组治疗后LDL-C水平对比，差异无统计学意义（P>0.05）。治疗后，对照组收缩压、舒张压（121.03±14.28）mmHg（1 mmHg=0.133 kPa）、（84.01±9.62）mmHg，研究组（116.81±15.41）mmHg、（81.98±8.56）mmHg，差异均无统计学意义（均P>0.05）。对照组药物不良反应发生率为11.54%（6/52），研究组为13.46%（7/52），差异无统计学意义（P>0.05）。结论　甘精胰岛素联合司美格鲁肽注射液治疗血糖控制不佳的T2DM合并高血压患者可有效控制患者糖脂代谢水平，改善患者胰岛功能，且安全性良好。

关键词:

2型糖尿病, 高血压, 甘精胰岛素, 司美格鲁肽