关键词: 糖尿病, 2型, 冠心病, 度拉糖肽

Abstract: Objective To investigate the effect of dulaglutide, glucagon-like peptide-1 receptor agonist (GLP-1RA) weekly preparation, on total load of myocardial ischemia and endothelial function in patients with type 2 diabetes mellitus (T2DM) complicated with coronary heart disease (CHD). 
Methods One hundred and twelve patients with T2DM complicated with CHD were randomly divided into two groups: conventional treatment group (n=56) and dulaglutide treatment group (n=56). The conventional treatment group was treated with standard hypoglycemic, hypotensive, lipid-lowering and antiplatelet therapy, while the dulaglutide treatment group was treated with dulaglutide injection (1.5 mg, subcutaneously, once a week) in addition to the conventional treatment. The clinical manifestations, body mass index (BMI), blood pressure, fasting blood glucose (FPG) , blood lipids and glycosylated hemoglobin (HbA1c) were observed before treatment and at 3 months after treatment in both groups respectively. In the meantime, the total load of myocardial ischemia, vascular endothelial function, and inflammatory indicators ［endothelin-1(ET-1), nitric oxide (NO) and hypersensitive C-reactive protein (hs-CRP)］ were measured. 
Results After treatment, FPG and LDL-C in both groups were lower than those before treatment. BMI, HbA1c, TG, and ACR in the dulaglutide treatment group were lower than those before treatment, while BMI, LDL-C, and ACR in the dulaglutide treatment group were lower than those in the conventional treatment group (P＜0.05) . The daily dose of insulin glargine and the incidence of hypoglycemia in the conventional treatment group were lower than those in the conventional treatment group (P＜0.05) . The total load of myocardial ischemia in both groups was significantly lower than that before treatment, which was significantly lower in dulaglutide treatment group than that in conventional treatment group after treatment (P＜0.05) . The levels of ET-1 and hs-CRP in two groups were lower than those before treatment, while the levels of NO were higher than those before treatment. The levels of ET-1 and hs-CRP were lower and the levels NO were higher in the  dulaglutide treatment group than in the conventional treatment group (P＜0.05). 
Conclusion Dulaglutide has multiple benefits in T2DM patients by lowering blood glucose, regulating lipid and reducing body weight, and has cardiovascular protective effects by anti-inflammation and protecting endothelial function. It can also improve myocardial blood supply, decrease total load of myocardial ischemia and improve prognosis by reducing and delaying the progression of coronary atherosclerosis in patients with T2DM complicated with CHD. 

Key words: diabetes mellitus, type 2, coronary disease, dulaglutide