司美格鲁肽治疗对超重或肥胖T2DM患者 糖尿病缓解及内脏脂肪减少的疗效观察

Effect of Smeglutide on Diabetes Mellitus Remission and Visceral Fat Reduction in Overweight or Obese Patients with T2DM

摘要: 目的：观察司美格鲁肽用于病程五年内单药二甲双胍血糖控制不佳的超重或肥胖T2DM患者的临床疗效。并探究影响糖尿病缓解的因素。方法：收集2024年10月至2025年6月就诊于保定市第二医院内分泌科住院部的病程五年内单药二甲双胍血糖控制不佳的超重或肥胖的2型糖尿病患者80例，给予司美格鲁肽、二甲双胍联合治疗3个月并进行纵向随访。比较治疗前及疗程结束后第12周后的FPG、2hPG、FINS、FCP、HOMA-IR、HOMA-β、HbA1c、BMI、VFA。无降糖药物治疗的情况下根据患者3个月的血糖情况分为缓解组与未缓解组。比较两组各指标的差异，筛选影响T2DM缓解的因素。结果：(1) 患者疗程结束12周后FPG、2hPG、HbA1c、HOMA‐IR、VFA、BMI水平低于治疗前(P < 0.05)，FINS、FCP、HOMA‐β水平高于治疗前(P < 0.05)；(2) T2DM缓解率达35.94%；(3) 治疗前缓解组糖尿病病程短于未缓解组(P < 0.05)，余基线资料比较差异均无统计学意义(P > 0.05)；(4) 缓解组ΔFPG、Δ2hPG、ΔHOMA-IR、ΔHbA1c、ΔVFA%、ΔBMI%低于未缓解组(P < 0.05)；缓解组ΔHOMA-β高于未缓解组(P < 0.05)。两组ΔFINS、ΔFCP差异无统计学意义(P > 0.05)；(5) 多因素二元Logistic回归显示，糖尿病病程、ΔVFA%均是糖尿病缓解的独立危险因素(P < 0.05)。结论：司美格鲁肽用于单药二甲双胍血糖控制不佳的病程五年内超重或肥胖T2DM患者降糖、减重、减少内脏脂肪的疗效较好，且安全性较好。糖尿病病程越短，内脏脂肪减少越多，越容易实现糖尿病缓解。

Abstract: Objective: To observe the clinical efficacy of semeglutide in overweight or obese T2DM patients with poor glycemic control with single agent metformin within five years of disease duration. And explore the factors affecting the remission of diabetes. Methods: A total of 80 overweight or obese patients with type 2 diabetes who were treated in the Department of Endocrinology, Baoding Second Hospital from October 2024 to June 2025 and had poor glycemic control with single agent metformin within five years were collected. They were treated with simeglutide and metformin for 3 months and were followed up longitudinally. FPG, 2hPG, fins, FCP, HOMA-IR, HOMA-β, HbA1c, BMI, VFA were compared before treatment and after the 12th week of treatment. The patients were divided into remission group and non remission group according to the blood glucose of the patients for 3 months without hypoglycemic drug treatment. The differences of each index between the two groups were compared, and the factors affecting the remission of T2DM were screened. Results: (1) The levels of FPG, 2hPG, HbA1c, HOMA-IR, VFA and BMI after 12 weeks of treatment were lower than those before treatment (P < 0.05), and the levels of FINS, FCP and HOMA-β were higher than those before treatment (P < 0.05); (2) The remission rate of T2DM was 35.94%; (3) Before treatment, the duration of diabetes in the remission group was shorter than that in the non remission group (P < 0.05), and there was no significant difference in other baseline data (P > 0.05); (4) Δ FPG, Δ2hPG, ΔHOMA-IR, ΔHbA1c, ΔVFA%, and ΔBMI% in the remission group were lower than those in the non remission group (P < 0.05); ΔHOMA-β in remission group was higher than that in non remission group (P < 0.05). There was no significant difference in ΔFINS and ΔFCP between the two groups (P > 0.05); (5) Multivariate binary logistic regression showed that DD and ΔVFA% were independent risk factors for diabetes remission (P < 0.05). Conclusion: Smeglutide is effective and safe in reducing glucose, weight and visceral fat in overweight or obese T2DM patients with poor glycemic control of single agent metformin within five years. The shorter the duration of diabetes, the more visceral fat reduction, the easier to achieve diabetes remission.