目的 探讨利拉鲁肽与甘精胰岛素对2型糖尿病患者血糖波动及血脂水平的影响。方法 选取2022年6月—2022年10月南京医科大学附属南京医院收治的174例2型糖尿病患者，按随机数字表法分为利拉鲁肽组与甘精胰岛素组，每组87例。利拉鲁肽组给予利拉鲁肽治疗，甘精胰岛素组给予甘精胰岛素治疗。比较两组治疗前后的体质量指数（BMI）、血糖、血脂、血糖波动及不良反应。结果 两组总有效率比较，差异无统计学意义（P >0.05）。利拉鲁肽组治疗前后BMI的差值低于甘精胰岛素组（P <0.05），血糖水平的标准差、平均血糖波动幅度、最大血糖波动幅度、每日平均血糖的差值高于甘精胰岛素组（P <0.05）。利拉鲁肽组与甘精胰岛组治疗前6：00～14：00、14：00～22：00、22：00～第2天6：00的三餐后及夜间血糖在目标范围内的时间百分比（TIR）、三餐后及夜间血糖高于目标范围的时间百分比（TAR）、三餐后及夜间血糖低于目标范围的时间百分比（TBR）比较，结果 ①不同时间段TIR、TAR、TBR比较，差异均无统计学意义（P >0.05）；②利拉鲁肽组与甘精胰岛组TIR、TAR、TBR值比较，差异均无统计学意义（P >0.05）；③两组TIR、TAR、TBR变化趋势比较，差异均无统计学意义（P >0.05）。利拉鲁肽组与甘精胰岛组治疗后6：00～14：00、14：00～22：00、22：00～第2天6：00的TIR、TAR、TBR比较，结果 ①不同时间段TIR、TAR、TBR比较，差异均有统计学意义（P <0.05）；②利拉鲁肽组与甘精胰岛组TIR、TAR、TBR比较，差异均有统计学意义（P <0.05），利拉鲁肽组在控制血糖波动作用方面优于甘精胰岛素组；③两组TIR、TAR、TBR变化趋势比较，差异均有统计学意义（P <0.05）。利拉鲁肽组治疗前后总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇的差值均高于甘精胰岛素组（P <0.05）。两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 虽然2型糖尿病患者使用甘精胰岛素可减少血糖波动，但明显不如利拉鲁肽改善血糖波动的效果好，并且利拉鲁肽改善血脂水平的效果优于甘精胰岛素。

Objective To investigate the effects of liraglutide and insulin glargine on blood glucose fluctuations and lipid levels in type 2 diabetic patients.Methods The 174 patients with type 2 diabetes admitted to our hospital from June 2022 to October 2022 were selected and divided into the liraglutide group and insulin glargine group by the random number table method, with 87 cases in each group. The liraglutide group was treated with liraglutide, while the insulin glargine group was treated with insulin glargine. The body mass index (BMI), blood glucose, blood lipids, blood glucose fluctuations, and adverse reactions were compared between two groups before and after treatment.Results There was no significant difference in the overall effective rate between the two groups (P > 0.05). The difference of BMI before and after treatment in the liraglutide group was lower than that in the insulin glargine group (P < 0.05). The differences of the standard deviation of the level of blood glucose, mean amplitude of glycemic excursions, largest amplitude of glycemic excursions and average daily blood glucose before and after treatment in the liraglutide group were higher than those in the insulin glargine group (P < 0.05). Before treatment, the time in range (TIR), time above range (TAR), and time below range (TBR) during time slots from 6:00 to 14:00, 14:00 to 22:00, and 22:00 to 6:00 the next day in the two groups were compare via repeated measures analysis of variance, which exhibited that there was no statistically significant difference in TIR, TAR and TBR among different time slots (P > 0.05) or between the groups (P > 0.05), and that the change trends of TIR, TAR and TBR were not different between the groups (P > 0.05). Similar comparison after treatment demonstrated that there were statistically significant differences in TIR, TAR and TBR among the time slots (P < 0.05) and between the groups (P < 0.05), and that the efficacy of liraglutide in controlling blood glucose fluctuations was superior to that of insulin glargine. Besides, the change trends of TIR, TAR and TBR were different between the groups (P < 0.05). The differences of levels of total cholesterol, triacylglycerol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol before and after treatment in the liraglutide group were higher than those in the insulin glargine group (P < 0.05). There was no significant difference in the overall incidence of adverse reactions between the two groups (P > 0.05).Conclusion Though insulin glargine can reduce blood glucose fluctuations in patients with type 2 diabetes, it is significantly less effective when compared with liraglutide. In addition, liraglutide shows greater efficacy in improving blood lipid levels than insulin glargine.

R587.1

江苏省自然科学基金面上项目（No：BK20211130）