关键词: 糖尿病,2型, 达格列净, 二甲双胍

Abstract: Objective To investigate the regulatory effect of metformin combined with dapagliflozin on the body′s glycolipid index, visceral adipose and chronic inflammatory stimulation in the treatment of poorly controlled type 2 diabetes mellitus (T2DM). 
Methods A total of 100 obese/overweight T2DM patients with poor response to metformin alone were selected and divided into control group (n=50) and observation group (n=50) by random number table method. The control group was given metformin combined with acarbose, and the observation group was given metformin combined with dapagliflozin. The blood glucose levels ［fasting plasma glucose (FPG), 2 h postprandial blood glucose (2 hPG), glycosylated hemoglobin A1c (HbA1c)］, homeostatic model assessment insulin resistance (HOMA-IR), blood lipids ［total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C)］, fat regulation indexes ［Nesfatin-1, adiponectin (APN), visfatin, leptin, resistin］, waist circumference, waist-to-hip ratio, body weight, visceral adipose (VA) on the umbilical plane, chronic inflammatory response indexes ［C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1)］ and adverse reactions were compared between the two groups. 
Results Two cases were lost to follow-up in the observation group and one case in the control group. The difference of interaction between groups, time points and time points between groups were statistically significant with respect to FPG, 2 hPG, HbA1c, HOMA-IR, TC, TG, HDL-C, LDL-C, Nesfatin-1, APN, visfatin, leptin, resistin, waist circumference, waist-to-hip ratio, body weight, VA, CRP, IL-6, TNF-α and MCP-1 was statistically significant (P＜0.05). There was no significant difference in the incidence of adverse reactions between two groups (P＞0.05). 
Conclusion Dapagliflozin adjuvant treatment has a good effect on improving the lipid metabolism, visceral adipose, and chronic inflammatory stimulation in obese/overweight T2DM patients with poor response to metformin. It can effectively relieve insulin resistance with good safety, and has broad clinical application prospects.

Key words: diabetes mellitus, type 2, dapagliflozin, metformin