Abstract: Objective To explore the efficacy and safety of three sequential hypoglycemic regimens in overweight/obese type 2 diabetes mellitus (T2DM) after short-term intensive hypoglycemic therapy. 
Methods A total of 99 overweight/obese T2DM patients admitted to the Department of Endocrinology of Hai′an People′s Hospital were selected. All patients were treated with continuous subcutaneous insulin infusion (CSII), followed by sequential hypoglycemic therapy after intensive hypoglycemic therapy. They were divided into three groups according to different sequential hypoglycemic regimens, with 33 cases in each group. Group A was given glimepiride + metformin, group B was given subcutaneous injection of dulaglutide 1.5 mg (once a week) + metformin, and group C was given insulin aspart 30 + metformin for a total course of 12 weeks. The body weight, blood glucose and C-peptide levels at 12 weeks after treatment were measured, and the patients′ medication compliance and hypoglycemia within 1 year were calculated. 
Results After treatment, body mass index (BMI) in group A was increased, BMI, and waist to hip ratio (WHR) in group B were decreased, and BMI and WHR in group C were increased (P＜0.05). BMI and WHR in group B were lower than those in groups A and C (P＜0.05). The levels of fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c) in the three groups were decreased after treatment (P＜0.05), and the levels of FBG in groups A and B after treatment were higher than those in group C (P＜0.05). There was no significant difference in HbA1c level and HbA1c compliance rate among the three groups after treatment (P＞0.05). The level of fasting c-peptide (F-CP) was decreased and the level of postprandial 2 h C peptide (2 h P-CP) was increased in group B after treatment (P＜0.05). The level of F-CP in group B was lower than that in groups A and C, while the level of 2 hP-CP in group B was higher than that in groups B and C (P＜0.05). The total compliance rates of patients in groups A, B and C were 70.97% (22/31), 96.77% (30/31) and 83.87% (26/31), respectively. The total compliance rate of patients in group A was lower than that in group B (P＜0.05). The incidences of hypoglycemia during sequential treatment in T2DM patients in groups A, B, and C were 19.35% (6/31), 9.68% (3/31), and 48.39% (15/31), respectively, and the incidence of hypoglycemia in groups A and B was lower than that in group C (P＜0.05).  
Conclusion Compared with three sequential hypoglycemic regimens, dulaglutide combined with metformin has obvious advantages in weight, blood sugar control and improvement of islet B cell function after short-term intensive hypoglycemic therapy in overweight/obese T2DM. In addition, the regimen has higher medication compliance during treatment, lower incidence of hypoglycemia, and higher efficacy and safety. 

Key words: diabetes mellitus, type 2； obesity; , overweight； insulin-secreting cells