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Volume 42 Issue 7
Jul.  2024
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MAO Zhiyi, WANG Xiaoyan, CHEN Xiaoying, TANG Yifei. Effects of dulaglutide combined with metformin on body metabolism, body fat composition and serum adipokines in obese patients with type 2 diabetes mellitus[J]. Journal of Pharmaceutical Practice and Service, 2024, 42(7): 305-309. doi: 10.12206/j.issn.2097-2024.202305032
Citation: MAO Zhiyi, WANG Xiaoyan, CHEN Xiaoying, TANG Yifei. Effects of dulaglutide combined with metformin on body metabolism, body fat composition and serum adipokines in obese patients with type 2 diabetes mellitus[J]. Journal of Pharmaceutical Practice and Service, 2024, 42(7): 305-309. doi: 10.12206/j.issn.2097-2024.202305032

Effects of dulaglutide combined with metformin on body metabolism, body fat composition and serum adipokines in obese patients with type 2 diabetes mellitus

doi: 10.12206/j.issn.2097-2024.202305032
  • Received Date: 2023-05-19
  • Rev Recd Date: 2024-02-21
  • Available Online: 2024-07-16
  • Publish Date: 2024-07-25
  •   Objective  To explore the clinical efficacy of dulaglutide combined with metformin in the treatment of obese patients with type 2 diabetes mellitus(T2DM).   Methods  A total of 200 obese patients with T2DM who were treated in Shanghai Jiading District Anting Hospital from January 2021 to January 2023 were randomly divided into liraglutide group(n=100)and dulaglutide group(n= 100). The liraglutide group was treated with liraglutide combined with metformin, and the dulaglutide group was treated with dulaglutide combined with metformin. Both groups were treated for 3 months. The body metabolic indexes [fasting blood glucose(FBG), 2 h postprandial blood glucose(2 h PBG), hemoglobin(HbA1 c), total cholesterol(TC), triglyceride(TG)], body fat composition [body fat rate, body mass index, subcutaneous fat rate of limbs, visceral fat index] and serum adipokines(adiponectin, neuropeptide Q(NPQ), asprosin, irisin)levels were compared before treatment and 3 months after treatment. The clinical efficacy and adverse reactions of the two groups were observed.   Results  After 3 months of treatment, FBG, 2 h PBG, HbAlc, TC, TG, body fat rate, body mass index, subcutaneous fat rate of limbs, visceral fat index and asprosin in the two groups were lower than those before treatment, and those in the dulaglutide group were lower than those in the liraglutide group(P<0.05). After 3 months of treatment, the levels of serum adiponectin, NPQ and irisin in the two groups were higher than those before treatment, and the increase in the dulaglutide group was greater than that in the liraglutide group(P<0.05). The effective rate of dulaglutide group(98.00%)was higher than that of liraglutide group(91.00 %)(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(11.00%, 14.00%)(P>0.05).   Conclusion  Dulaglutide combined with metformin could improve the metabolic status of obese T2 DM patients, regulate body fat composition and serum adipokines, with significant clinical efficacy and safety.
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    [2] 马洪川, 陈华玲, 朱瑞, 等. 达格列净联合二甲双胍治疗肥胖2型糖尿病及对血清补体、氧化应激因子和血液流变学的影响[J]. 临床和实验医学杂志, 2021, 20(12):1271-1275.
    [3] 母义明, 李春霖, 纪立农, 等. 二甲双胍临床应用专家共识(2018年版)[J]. 中国糖尿病杂志, 2019, 27(3):161-173.
    [4] 韩洁, 张伟, 孙茜, 等. 利拉鲁肽调控SIRT1/AMPK通路改善初诊超重/肥胖2型糖尿病患者糖脂代谢的研究[J]. 临床和实验医学杂志, 2021, 20(23):2527-2531.
    [5] 范晓琳, 杨小华, 刘华, 等. 度拉糖肽联合密盖息鼻喷剂治疗2型糖尿病合并骨质疏松患者的疗效及对炎症和脂肪因子影响的研究[J]. 中国糖尿病杂志, 2023, 31(2):108-112.
    [6] 陆菊明. 《中国2型糖尿病防治指南(2020年版)》读后感[J]. 中华糖尿病杂志, 2021, 13(4):301-304.
    [7] 刘倩, 魏爱生, 刘天. 度拉糖肽联合生酮饮食治疗肥胖2型糖尿病效果观察[J]. 山东医药, 2020, 60(14):51-53.
    [8] 中国研究型医院学会糖尿病学专业委员会. 成人2型糖尿病患者口服降糖药物三联优化方案(二甲双胍+二肽基肽酶4抑制剂+钠? 葡萄糖共转运蛋白2抑制剂)中国专家共识[J]. 中国糖尿病杂志, 2021, 29(8):561-570.
    [9] DOYLE-DELGADO K, CHAMBERLAIN J J, SHUBROOK J H, et al. Pharmacologic approaches to glycemic treatment of type 2 diabetes: synopsis of the 2020 American diabetes association’s standards of medical care in diabetes clinical guideline[J]. Ann Intern Med, 2020, 173(10):813-821. doi:  10.7326/M20-2470
    [10] 王素莉, 符婷, 刘丽楠, 等. 探讨两种胰高血糖素样肽-1激动剂对口服降糖药未控制的2型糖尿病患者的治疗效果及安全性[J]. 临床和实验医学杂志, 2022, 21(16):1708-1712.
    [11] 李秋胜, 李靓, 杨飒. 度拉糖肽与利拉鲁肽对肥胖性2型糖尿病患者BMI及血糖水平的影响[J]. 中国处方药, 2023, 21(7):143-146.
    [12] 周灿, 李青. GLP-1受体激动剂周制剂度拉糖肽对早期糖尿病肾病的影响[J]. 湖南师范大学学报(医学版), 2021, 18(6):85-87.
    [13] 汤冉, 杜国利. 肥胖合并糖尿病中脂肪组织巨噬细胞极化相关信号通路研究进展[J]. 临床医学进展, 2023(3):3431-3437.
    [14] ZAIDI H N, BYRKJELAND R, NJERVE I U, et al. Adiponectin in relation to exercise and physical performance in patients with type 2 diabetes and coronary artery disease[J]. Adipocyte, 2021, 10(1):612-620. doi:  10.1080/21623945.2021.1996699
    [15] 顾丽萍, 申婷婷, 马宇航, 等. 新诊断2型糖尿病患者血清spexin水平与内脏脂肪面积及代谢指标的相关性分析[J]. 同济大学学报(医学版), 2020, 41(2):172-177.
    [16] 寇菲, 黄晓霞, 徐德秋. 人血清Irisin和SFRP5水平变化与2型糖尿病合并肥胖患者的关系研究[J]. 国际免疫学杂志, 2020, 43(1):37-41.
    [17] JIANG A Q, FENG Z R, YUAN L, et al. Effect of sodium–glucose co-transporter-2 inhibitors on the levels of serum asprosin in patients with newly diagnosed type 2 diabetes mellitus[J]. Diabetol Metab Syndr, 2021, 13(1):34. doi:  10.1186/s13098-021-00652-5
    [18] 胡雅楠, 李苗, 李宝新, 等. 血清硫氧还蛋白和白脂素在糖尿病前期及糖尿病患者中的变化及影响因素分析[J]. 解放军医学院学报, 2022, 43(2):139-144.
    [19] 武艳丽, 刘俊芳, 杨永歆. 度拉糖肽和利拉鲁肽联合二甲双胍治疗超重及肥胖2型糖尿病的比较研究[J]. 现代药物与临床, 2021, 36(5):957-960.
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Effects of dulaglutide combined with metformin on body metabolism, body fat composition and serum adipokines in obese patients with type 2 diabetes mellitus

doi: 10.12206/j.issn.2097-2024.202305032

Abstract:   Objective  To explore the clinical efficacy of dulaglutide combined with metformin in the treatment of obese patients with type 2 diabetes mellitus(T2DM).   Methods  A total of 200 obese patients with T2DM who were treated in Shanghai Jiading District Anting Hospital from January 2021 to January 2023 were randomly divided into liraglutide group(n=100)and dulaglutide group(n= 100). The liraglutide group was treated with liraglutide combined with metformin, and the dulaglutide group was treated with dulaglutide combined with metformin. Both groups were treated for 3 months. The body metabolic indexes [fasting blood glucose(FBG), 2 h postprandial blood glucose(2 h PBG), hemoglobin(HbA1 c), total cholesterol(TC), triglyceride(TG)], body fat composition [body fat rate, body mass index, subcutaneous fat rate of limbs, visceral fat index] and serum adipokines(adiponectin, neuropeptide Q(NPQ), asprosin, irisin)levels were compared before treatment and 3 months after treatment. The clinical efficacy and adverse reactions of the two groups were observed.   Results  After 3 months of treatment, FBG, 2 h PBG, HbAlc, TC, TG, body fat rate, body mass index, subcutaneous fat rate of limbs, visceral fat index and asprosin in the two groups were lower than those before treatment, and those in the dulaglutide group were lower than those in the liraglutide group(P<0.05). After 3 months of treatment, the levels of serum adiponectin, NPQ and irisin in the two groups were higher than those before treatment, and the increase in the dulaglutide group was greater than that in the liraglutide group(P<0.05). The effective rate of dulaglutide group(98.00%)was higher than that of liraglutide group(91.00 %)(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(11.00%, 14.00%)(P>0.05).   Conclusion  Dulaglutide combined with metformin could improve the metabolic status of obese T2 DM patients, regulate body fat composition and serum adipokines, with significant clinical efficacy and safety.

MAO Zhiyi, WANG Xiaoyan, CHEN Xiaoying, TANG Yifei. Effects of dulaglutide combined with metformin on body metabolism, body fat composition and serum adipokines in obese patients with type 2 diabetes mellitus[J]. Journal of Pharmaceutical Practice and Service, 2024, 42(7): 305-309. doi: 10.12206/j.issn.2097-2024.202305032
Citation: MAO Zhiyi, WANG Xiaoyan, CHEN Xiaoying, TANG Yifei. Effects of dulaglutide combined with metformin on body metabolism, body fat composition and serum adipokines in obese patients with type 2 diabetes mellitus[J]. Journal of Pharmaceutical Practice and Service, 2024, 42(7): 305-309. doi: 10.12206/j.issn.2097-2024.202305032
  • 糖尿病为世界三大慢性病之一,据国际糖尿病联盟调查报道,2019年全球约有4.6亿人罹患2型糖尿病(T2DM),中国占30.45%,且全球每年超400万患者死于糖尿病并发症[1]。二甲双胍是临床治疗T2DM首选药物,降血糖效果显著,且具有一定的减重作用[2]。有报道表明[3],肥胖患者内脏脂肪更容易沉积,会降低胰岛素敏感性,影响临床疗效。因此,临床上多用二甲双胍联合其他药物治疗肥胖型T2DM。美国糖尿病学会于2019年在糖尿病诊疗标准中建议有减重需求的T2DM患者可优先考虑胰高血糖素样肽(GLP-1)类似物。利拉鲁肽作为GLP-1类似物日制剂,可促进胰岛细胞再生,保护心血管系统,临床常将其与二甲双胍联合用于治疗肥胖型T2DM[4]。而度拉糖肽是新型GLP-1类似物,每周注射1次,长期治疗肥胖型T2DM患者依从性更高[5]。脂肪组织已被证实可以合成和分泌脂肪因子,参与调控体内糖脂能量,且部分脂肪因子也被证实参与了肥胖人群胰岛素抵抗病理过程,因此研究其治疗过程中的水平变化对评估临床疗效意义重大。但关于度拉糖肽、利拉鲁肽分别联合二甲双胍用于肥胖型T2DM的疗效优劣及对血清脂肪因子的影响鲜有报道。故本研究进行对照分析,从机体代谢、体脂成分、脂肪因子等方面探究度拉糖肽联合二甲双胍的应用价值,以期为今后的临床治疗提供参考依据。

    • 将2021—2023上海市嘉定区安亭医院符合入组条件的肥胖型T2DM患者200例,按入院顺序排序1~200,采用电脑随机数字表法分组,将患者按1∶1配对原则分配,每位患者赋予1个随机数,随机数序号为1~100为利拉鲁肽组,101~200为度拉糖肽组。纳入条件:①符合《中国2型糖尿病防治指南(2020年版)》[6]中T2DM的相关诊断标准;②体重指数≥28 kg/m2;③精神正常、具有较好沟通能力,可遵医嘱完成治疗;④入组前单用二甲双胍治疗(500 mg/次,2次/d),且效果不佳;⑤对本研究相关药物无过敏;⑥患者或家属签署同意书。排除条件:①1型糖尿病;②近期接受其他减肥方案;③合并严重心脑血管疾病;④脏器功能严重不全;⑤合并肾脏移植、近期胃肠手术史;⑤合并全身感染性疾病、免疫系统疾病。该研究通过本院伦理委员会审批,且遵循《赫尔辛基宣言》中相关原则。2组临床资料相比,均无统计学差异(P>0.05),具有可比性,见表1

      组别 性别[例(%)] 年龄
      ($ \bar x $±s,岁)
      病程
      ($ \bar x $±s,年)
      合并症[例(%)]
      高血压 冠心病 高脂血症 吸烟史 饮酒史
      利拉鲁肽组
      45(45.00) 55(55.00) 59.77±4.65 5.98±1.31 20(20.00) 8(8.00) 7(7.00) 37(37.00) 48(48.00)
      度拉糖肽组
      53(53.00) 47(47.00) 60.18±4.47 6.15±1.38 25(25.00) 11(11.00) 5(5.00) 34(34.00) 53(53.00)
      χ2 1.281 0.636 0.893 0.717 0.523 0.355 0.197 0.500
      P 0.258 0.526 0.373 0.397 0.469 0.552 0.658 0.480
    • 2组均给予常规饮食、运动指导。利拉鲁肽组给予利拉鲁肽联合二甲双胍治疗,利拉鲁肽注射液(批准文号:S20160005,Novo Nordisk A/S,规格:3 ml/18 mg)皮下注射,初始剂量0.6 mg/次,根据患者情况增加,最大剂量1.8 mg/次,1次/d;二甲双胍片(批准文号:国药准字H20184066,四川维奥制药有限公司,规格:025 g)口服,500 mg/次,2次/d。度拉糖肽组给予度拉糖肽联合二甲双胍治疗,二甲双胍用法用量同利拉鲁肽组;度拉糖肽注射液(批准文号:S20190021,Vetter Pharma-Fertigung GmbH & Co. KG,规格:1.5 mg/0.5 ml)皮下注射,1.5 mg/次,1次/周。2组均治疗3个月进行指标评价。

    • 参照相关疗效标准[7],显效:血清空腹血糖(FBG)、餐后2 h血糖(2 h PBG)恢复正常或较治疗前降低>40%,血红蛋白(HbA1c)恢复正常或较治疗前降低>30%,体质量在标准值上下20%内;有效:血清FBG、2 h PBG较治疗前降低21%~40%,HbAlc较治疗前降低11%~30%,体质量降低>2 kg。无效:未达有效标准或病情加重。有效率=(显效例数+有效例数)/100×100%。

    • ①治疗前与治疗3个月,采集静脉血,采用葡萄糖氧化酶法检测FBG、2 h PBG水平,试剂盒购自济南百博生物技术股份有限公司;采用免疫比浊法检测HbA1c水平,试剂盒购自北京利德曼生化股份有限公司;全自动生化分析仪(cobas 8000 c 701型,罗氏诊断公司)检测总胆固醇(TC)、甘油三酯(TG)水平。②血清脂联素(adiponectin)、神经肽Q(NPQ)、白脂素(asprosin)、鸢尾素(irisin)水平均采用酶联免疫法进行检测,试剂盒均购自Bio-Rad Laboratories, Inc.。③以体重身体脂肪检测器(HBF-701SH型,欧姆龙公司)记录体脂肪率、体重指数、四肢皮下脂肪率、内脏脂肪指数。④记录治疗期间患者腹部不适、低血糖、呕吐、恶心等不良反应情况。

    • 采用SPSS25.0进行数据分析,连续变量采用($ \bar x $±s)描述,以独立样本或配对t进行检验;分类变量以[例(%)]描述,以校正或未校正χ2检验,以P<0.05为差异有统计学意义。

    • 2组治疗前FBG、2 h PBG、HbAlc、TC、TG水平相比,均无统计学差异(P>0.05)。2组治疗3个月FBG、2 h PBG、HbAlc、TC、TG均较治疗前改善,且度拉糖肽组改善幅度较大(P<0.05),结果见表2

      组别 时间 FBG(cB/mmol·L−1 2 h PBG(cB/mmol·L−1 HbAlc(%) TC(cB/mmol·L−1 TG(cB/mmol·L−1
      利拉鲁肽组 治疗前 9.87±0.73 14.21±2.11 9.52±0.85 5.08±0.48 2.39±0.28
      治疗3个月 6.92±0.49# 8.65±0.97# 7.39±0.41# 4.72±0.35# 1.94±0.25#
      度拉糖肽组 治疗前 9.91±0.69 13.98±2.26 9.44±0.79 5.02±0.51 2.41±0.30
      治疗3个月 6.64±0.51*# 8.19±1.01*# 6.81±0.36*# 4.48±0.29*# 1.62±0.27*#
      *P<0.05,与利拉鲁肽组比较;#P<0.05,与本组治疗前比较。
    • 治疗前,度拉糖肽组体脂肪率、体重指数、四肢皮下脂肪率、内脏脂肪指数与利拉鲁肽组相比,均无统计学差异(P>0.05)。治疗3个月,2组体脂肪率、体重指数、四肢皮下脂肪率、内脏脂肪指数低于治疗前,且度拉糖肽组较利拉鲁肽组低(P<0.05),结果见表3

      组别 时间 体脂肪率(%) 体重指数(kg/m2 四肢皮下脂肪率(%) 内脏脂肪指数(%)
      利拉鲁肽组 治疗前 34.71±1.53 30.08±0.95 38.72±7.38 13.47±2.08
      治疗3个月 32.08±1.16# 27.35±1.24# 35.81±4.05# 12.15±0.98#
      度拉糖肽组 治疗前 34.95±1.61 30.22±0.73 39.03±8.29 13.68±1.96
      治疗3个月 31.20±1.27*# 26.61±1.08*# 34.29±3.17*# 11.34±1.05*#
      *P<0.05,与利拉鲁肽组比较;#P<0.05,与本组治疗前比较。
    • 2组治疗前血清adiponectin、NPQ、asprosin、irisin水平相比,均无统计学差异(P>0.05)。治疗3个月,2组血清adiponectin、NPQ、irisin水平均较治疗前升高,血清asprosin水平低于治疗前,且度拉糖肽组血清adiponectin、NPQ、irisin水平较利拉鲁肽组高,血清asprosin水平较利拉鲁肽组低(P<0.05),结果见表4

      组别 时间 adiponectin(ρB/mg·L−1 NPQ(ρB/ng•L−1 asprosin(ρB/μg·L−1 irisin(ρB/ng·L−1
      利拉鲁肽组 治疗前 3.62±0.79 915.73±208.43 2.25±0.51 2.85±0.76
      治疗3个月 4.28±1.02# 1577.93±234.61# 1.16±0.38# 4.12±0.84#
      度拉糖肽组 治疗前 3.74±0.81 932.39±211.34 2.19±0.47 2.91±0.79
      治疗3个月 6.21±1.17#* 1786.54±251.49#* 0.95±0.33#* 4.73±0.62#*
      #P<0.05,与本组治疗前比较;*P<0.05,与利拉鲁肽组比较。
    • 治疗3个月,度拉糖肽组有效率(98.00%),利拉鲁肽组有效率(91.00%),度拉糖肽组高于利拉鲁肽组(P<0.05),结果见表5

      组别显效有效无效有效率
      利拉鲁肽组54(54.00)37(37.00)9(9.00)91(91.00)
      度拉糖肽组63(63.00)35(35.00)2(2.00)98(98.00)
      χ24.714
      P0.030
    • 治疗期间度拉糖肽组不良反应发生率(11.00%)与利拉鲁肽组(14.00%)相比,无统计学差异(P>0.05),结果见表6

      组别恶心呕吐低血糖腹部不适发生率
      利拉鲁肽组(n=100)7(7.00)3(3.00)4(4.00)14(14.00)
      度拉糖肽组(n=100)6(6.00)2(2.00)3(3.00)11(11.00)
      χ20.411
      P0.521
    • 二甲双胍是国内外指南均推荐的T2DM一线治疗药物,其通过活化胰岛素,改善外周胰岛素抵抗,减少肝脏葡萄糖输出量,从而发挥降低血糖的作用,且可减轻患者体重[8-9]。肥胖作为T2DM的独立危险因素,其诱发高血糖机制更加复杂,会增加治疗难度。GLP-1是刺激胰岛素释放肠促胰素,可抑制β细胞凋亡,促使胰岛素合成及分泌,且经皮下注射,可显著降低血糖。另有研究表明,GLP-1通过可抑制胰腺α细胞合成胰高血糖素,有效减轻患者体重[10]。因此,以二甲双胍为基础的联合GLP-1方案是肥胖T2DM患者重要治疗方案。

      度拉糖肽和利拉鲁肽均为GLP-1类似药物,能作用于胰岛β细胞促使胰岛素释放,同时还能通过调控胃肠蠕动和胃部排空,控制血糖。李秋胜等[11]研究结果显示,度拉糖肽联合二甲双胍治疗T2DM有效率高于利拉鲁肽联合二甲双胍。本研究结果也显示,度拉糖肽组有效率98.00%高于利拉鲁肽组91.00%(P<0.05),与上述研究结果一致,进一步证实了度拉糖肽联合二甲双胍治疗肥胖型T2DM疗效确切。另外,治疗3个月后,2组FBG、2 h PBG、HbAlc、TC、TG、体脂肪率、体重指数、四肢皮下脂肪率、内脏脂肪指数均较治疗前降低(P<0.05),说明两种治疗方案均能改善机体糖脂代谢状态,调节体脂成分,对病情恢复具有积极意义。而度拉糖肽组上述指标降低幅度大于利拉鲁肽组(P<0.05),究其原因可能是:①度拉糖肽是新型长效性GLP-1药物,每周注射1次,且不受饮食等因素影响,使用更简便,可提高患者治疗依从性;②度拉糖肽是基因融合蛋白,与人体GLP-1同源程度超过90%,可更好发挥天然GLP-1作用,且相对分子质量较大,经过肾脏代谢速度较慢,可延长药效时间[12]。此外,二甲双胍具有降血糖与减重作用,但代谢速度也较快,度拉糖肽与其相结合,协同增效作用更为明显。度拉糖肽组治疗期间不良反应率与利拉鲁肽组比较,差异无统计学意义(P>0.05),表明度拉糖肽联合二甲双胍是肥胖T2DM安全可行的治疗方案。

      近年肥胖型T2DM患者逐渐增多,代谢调控细胞越来越受到临床关注,有可能成为临床治疗新靶点。有研究证实[13],脂肪组织属于机体内分泌器官,可合成和分泌脂肪因子,参与T2DM病理代谢进程。adiponectin、NPQ、irisin均为保护性脂肪因子,能改善胰岛素敏感性,维持机体能量代谢稳定。相关文献表明[14-16],T2DM患者血清adiponectin、NPQ、irisin水平低于正常人群,血糖控制后,血清上述指标水平升高,且升高幅度与血糖控制效果呈正相关。因此,血清adiponectin、NPQ、irisin水平可作为反映疾病预后效果的敏感性指标。asprosin作为肝脏脂肪因子,在胰岛素抵抗状态下呈高水平表达,会激活G蛋白相关信号通路促使肝葡萄糖释放,加快糖尿病的病理进程。且有研究[17-18]显示,葡萄糖依赖性刺激会抑制asprosin释放,且与胰岛素抵抗、肥胖、机体代谢密切相关。本研究显示,2组患者治疗3个月后血清adiponectin、NPQ、asprosin、irisin水平较治疗前均有改善,且度拉糖肽组血清adiponectin、NPQ、irisin水平高于利拉鲁肽组,asprosin水平低于利拉鲁肽组(P<0.05),提示度拉糖肽联合二甲双胍能更好地增强脂肪因子的调节效果。分析可能原因为,二甲双胍可降低食欲,减少能量摄入与体内脂肪含量;度拉糖肽也可抑制食欲,增加饱腹感,减少食物摄入量,二者联合能共同促进脂肪组织消耗、分解,抑制脂肪细胞合成,从而能更好地调节脂肪因子水平,但具体机制仍需进一步探索。肥胖型T2DM作为一种慢性疾病,其远期疗效一直是临床关注的焦点。武艳丽等[19]研究显示,随访6个月和1年,度拉糖肽的降糖疗效优于利拉鲁肽。但由于研究时间限制,本研究治疗结束后未进行随访,对机体体脂成分及血清脂肪因子的远期影响尚不明确,有待增加随访时间做进一步探究。

      综上可知,度拉糖肽与二甲双胍治疗肥胖型T2DM可提高临床疗效,促进糖脂代谢,并能调节体脂成分及血清脂肪因子,减轻患者肥胖症状,且具有较高安全性。但本研究为单中心研究,受选取样本量、治疗时间等因素影响,研究结果可能存在偏倚,有待扩大样本,延长治疗时间做进一步分析。

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