Abstract:

Objective　To explore the clinical efficacy of telmisartan combined with cagreliflozin for patients with type 2 diabetes mellitus (T2DM) and central obesity. Methods　This was a prospective study. Eighty-eight patients with T2DM and central obesity treated at Xi'an Daxing Hospital between January 2022 and January 2024 were selected as the study objects, and were divided into a reference group and a combination group by the random number table method, with 44 cases in each group. There were 24 males and 20 females in the reference group; they were 41-73 (54.83±9.97) years old; their T2DM course was 4-10 (6.49±1.31) years. There were 26 males and 18 females in the combination group; they were 42-72 (55.18±10.16) years old; their T2DM course was 4-9 (6.36±1.27) years. The reference group received basic treatment and orally took 100 mg of cagreliflozin once per day; in addition, the combination group orally took 80 mg of telmisartan once per day; both groups were treated for 6 months. The obesity-related indicators [body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and visceral fat area (VFA)], glycemic indicators [glycated hemoglobin (HbA1c), fasting blood glucose (FBG), and 2-hour postprandial blood glucose (2 hPBG)], pancreatic islet function [homeostasis model assessment for insulin resistance (HOMA-IR), homeostasis model assessment for beta-cell function (HOMA-β), and fasting insulin (FINS)], and cardiovascular indicators [endothelin-1 (ET-1), vascular endothelial growth factor (VEGF), and flow-mediated dilation (FMD)] before and after the treatment and incidence rates of adverse reactions were compared between the two groups. The statistical analysis was performed using the t and χ² tests. Results　After the treatment, the BMI, WC, WHR, VFA, HbA1c, FBG, 2 hPBG, and HOMA-IR in the combination group were lower than those in the reference group , while the FMD was higher, with statistical differences (t=7.139, 4.869, 2.909, 2.471, 2.743, 24.288, 3.696,26.441, and 7.508; all P0.05); the FMD in the combination group was higher than that in the reference group [(10.93±1.88)% vs. (8.27±1.41)%], while the levels of ET-1 and VEGF were lower [(63.20±7.72) ng/L vs. (69.17±8.88) ng/L and (8.14±1.29) ng/L vs. (9.46±1.57) ng/L], with statistical differences (t=7.508, 3.366, and 4.309; all P0.05). There was no statistical difference in the incidence rate of adverse reactions between the two groups (χ²=1.397; P0.05). Conclusion　Telmisartan combined with cagreliflozin for patients with T2DM and central obesity can improve their blood glucose and body weight indicators and regulate blood lipids, and is safe.

Key words:

Type 2 diabetes mellitus, Central obesity, Telmisartan, Cagreliflozin, Blood glucose

摘要：

目的　探讨替米沙坦联合卡格列净对2型糖尿病伴中心型肥胖患者的临床疗效。方法　采用前瞻性研究，选取2022年1月至2024年1月西安大兴医院接收的88例2型糖尿病伴中心型肥胖患者作为研究对象。通过随机数字表法将患者分为两组，各44例。参照组：男24例，女20例，年龄41～73（54.83±9.97）岁，2型糖尿病病程4～10（6.49±1.31）年；在基础治疗的同时进行卡格列净治疗（每次剂量为100 mg，每日口服1次）。联合组：男26例，女18例，年龄42～72（55.18±10.16）岁，2型糖尿病病程4～9（6.36±1.27）年；在参照组基础上联合替米沙坦治疗（每次剂量为80 mg，每日口服1次）。两组均治疗6个月。比较两组患者治疗前后的肥胖指标［体重指数（BMI）、腰围、腰臀比、内脏脂肪面积（VFA）］、血糖指标［糖化血红蛋白（HbA1c）、空腹血糖（FBG）、餐后2 h血糖（2 hPBG）］、胰岛功能［胰岛素抵抗指数（HOMA-IR）、胰岛β细胞功能指数（HOMA-β）、空腹胰岛素（FINS）］、心血管指标［血清内皮素-1（ET-1）、血管内皮生长因子（VEGF）、血管内皮依赖性舒张功能（FMD）］，以及不良反应发生情况。统计学方法采用t检验、χ²检验。结果　治疗后，联合组患者BMI、腰围、腰臀比、VFA、HbA1c、FBG、2 hPBG、HOMA-IR均低于参照组，FMD高于参照组，差异均有统计学意义（t=7.139、4.869、2.909、2.471、2.743、24.288、3.696、26.441、7.508，均P0.05）；联合组患者FMD水平高于参照组［（10.93±1.88）%比（8.27±1.41）%］，ET-1、VEGF水平均低于参照组［（63.20±7.72）ng/L比（69.17±8.88）ng/L、（8.14±1.29）ng/L比（9.46±1.57）ng/L］，差异均有统计学意义（t=7.508、3.366、4.309，均P0.05）。两组不良反应发生率比较，差异无统计学意义（χ²=1.397，P0.05）。结论　替米沙坦联合卡格列净能改善2型糖尿病伴中心型肥胖患者血糖和体重指标，调整血脂水平，治疗安全，适合临床推广应用。

关键词:

2型糖尿病, 中心型肥胖, 替米沙坦, 卡格列净, 血糖