关键词: 糖尿病,2型, 肥胖, 腹部, 二甲双胍

Abstract: Objective To observe the application of dapagliflozin in newly diagnosed type 2 diabetes mellitus (T2DM) patients with visceral fat obesity, and to explore the treatment scheme of T2DM patients with visceral fat obesity. 
Methods This study was a prospective randomized controlled study, with 90 newly diagnosed T2DM patients with visceral adiposity in Zhuhai People′s Hospital as the research subjects. A random number table method was used to divide them into groups A, B and C, with 30 cases in each group. The three groups were given general treatment, and on this basis, group A took Dagalijing Tablets, group B took Metformin Sustained-release Tablets, and group C took Dagalijing Tablets+Metformin Sustained-release Tablets; the intervention lasted for 12 weeks. At 12 weeks after intervention, the body weight, body mass index (BMI), glucose and lipid levels ［fasting blood glucose (FBG), 2 h postprandial blood glucose (2 hBG), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C)］, fat area (visceral fat area, subcutaneous fat area), human body composition (total body water, intracellular water, extracellular water and fat proportion), liver and kidney function ［aspartate transaminase (AST), alanine transaminase (ALT), serum creatinine (Scr), and urea nitrogen (BUN)］ and the incidence of adverse reactions during intervention were compared among three groups.  
Results At 12 weeks after intervention, the body weight and BMI of the three groups were lower than those before intervention, and the body weight and BMI of group C were lower than those of group A and group B, and lower in group A than in group B, suggesting significant differences (P＜0.05). At 12 weeks after intervention, the levels of FBG, 2 hBG, TC, TG, HbA1c, and LDL-C in the three groups were lower than those before the intervention, and the HDL-C levels were higher than those before the intervention; the improvement level was higher in group C than in group A and group B, and in group A than in group B, suggesting significant differences (P＜0.05). At 12 weeks after intervention, the area of visceral fat and subcutaneous fat in the three groups were decreased, and the percentage of fat was decreased, while the total body water, intracellular water and extracellular water were increased. The visceral fat area and subcutaneous fat area in group C were smaller than those in group A and group B, the fat percentage was lower than those in group A and group B, and the total body water, intracellular water and extracellular water were more than those in group A and group B. The visceral fat area and subcutaneous fat area in group A were smaller than those in group B, the fat percentage was lower than that in group B, and the total body water, intracellular water and extracellular water were more than those in group B, suggesting significant differences (P＜0.05). At 12 weeks after intervention, there was no statistical significant difference in AST and ALT levels among the three groups compared with those before intervention (P＞0.05). The levels of Scr and BUN in group A and C were lower than those before treatment and those in group B, and the difference was statistically significant (P＜0.05). There was no statistical significant difference in Scr and BUN levels in group B compared with those before treatment (P＞0.05). There was no statistical significant difference in the total incidence of adverse reactions among the three groups (P＞0.05). 
Conclusion The treatment of dapagliflozin combined with metformin in patients with T2DM complicated with visceral fat obesity can reduce the weight of patients by lowering blood glucose, lowering blood lipid and improving the content of body components, and dapagliflozin can play a role in renal protection. The combination has no obvious effect on liver and kidney function, and has certain safety. 

Key words: diabetes mellitus, type 2, obesity, abdominal, metformin