Volume 16 · Issue Z1 · 2024

A case of an elderly patient with type 2 diabetes mellitus (T2DM) treated in the outpatient department of endocrinology of Yuxi Hospital of Traditional Chinese Medicine in Yunnan Province was reported. The blood glucose control was not up to standard after oral drug treatment, and it was changed to combined with deguspart double insulin treatment, and good results were achieved. The patient was a 76-year-old female. The main reason was that her blood sugar had increased for more than 18 years, and she saw a doctor for 1 month with numbness and pain in her limbs. Combined treatment with acarbose 50 mg (3 times/d) + glimepiride 2 mg (2 times/d) + metformin enteric-coated tablets 0.5 g (3 times/d) before consultation, glycosylated hemoglobin (HbA_1c）8.7%。 The results of insulin release test showed that blood glucose increased significantly on fasting and at 1, 2, and 3 h postprandial, and the secretion curves of C peptide and insulin were low and flat. The treatment regimen was changed to insulin deguspart double 14 U subcutaneous injection before breakfast (once/d) + acarbose 50 mg (twice/d, orally at lunch and dinner) + metformin (0.5 g, three times/d), and the patient was discharged with good blood glucose control. After 3 months of discharge, the outpatient reexamination of fasting blood glucose was 6.3 mmol/L, 2 h after breakfast blood glucose was 8.9 mmol/L, HbA_1c6.8%。 The patient did not have hypoglycemia.

This paper reports a case of insulin optimization treatment in a patient with type 2 diabetes mellitus with long course of disease and poor islet function in the Department of Endocrinology, Hangzhou First People's Hospital affiliated to West Lake University School of Medicine, aiming to explore the timing and optimization of insulin reasonable use in clinical practice. The patient was an elderly woman who was admitted due to "blood sugar rise found for 10 years and low back pain for 2 days". After admission, all examinations were completed, and the diagnosis was acute pyelonephritis, type 2 diabetes mellitus with peripheral vascular disease, grade 2 hypertension, coronary heart disease, and postmenopausal osteoporosis. After this admission, we actively treated anti-infectious treatment, and re-evaluated pancreatic islet function after infection control. Considering that the patient's postprandial blood glucose increased significantly, it is necessary to formulate and optimize the insulin use plan, and switch to insulin deglutide liraglutide (19 U, once a night) + acarbose (0.1 g, 3 times/d) treatment. After that, the patient had serious digestive tract adverse reactions and repeated postprandial blood glucose failure. Finally, the dose of double insulin deglupart was adjusted to subcutaneous injection + acarbose (0.1 g, 3 times/d) at 10 U in the morning and 10 U in the evening, and was discharged for follow-up. After 3 months, fasting blood glucose was 5.4 mmol/L, 2 h postprandial blood glucose was 7.5 mmol/L, and glycosylated hemoglobin was 6.3%. The patient's blood glucose reached the standard and was controlled smoothly, and no hypoglycemic events occurred.

This paper reports the diagnosis and treatment of 2 newly diagnosed patients with type 2 diabetes mellitus (T2DM) who were treated with insulin deglutide liraglutide injection after short-term intensive insulin pump therapy in the Department of Endocrinology of Hebei Provincial People's Hospital. Case 1 was a 40-year-old male with an outpatient fasting blood glucose of 12.19 mmol/L. Body mass index (BMI) 39.14 kg/m², glycated hemoglobin (HbA_1c）11.5%。 Complication screening suggests moderate peripheral autonomic neuropathy. Case 2 was a 21-year-old male whose blood glucose was randomly measured to be 17 mmol/L and urine glucose 4+. BMI 28.98 kg/m², HbA_1c10.9%。 The results of glucose tolerance test, insulin release test and C-peptide release test in 2 patients showed insulin resistance, and all were diagnosed as T2DM. After admission, education, lifestyle intervention and insulin pump hypoglycemic treatment were given. The dosage of insulin pump was adjusted according to blood glucose level on the 2nd to 7th day. The patient's blood glucose improved compared with before, but it was still poorly controlled. Starting from the 8th day of hospitalization, the insulin pump was discontinued, and 20 and 24 dose units of insulin deglutide liraglutide injection (once/d) were injected subcutaneously before bed, plus metformin and dapagliflozin orally. The patient's blood glucose control was stable, without hypoglycemia and obvious gastrointestinal adverse reactions. At 3-month follow-up after discharge, Case 1 lost 8.5 kg of body weight, decreased abdominal circumference by about 10 cm, HbA_1c7.5%； Example 2 Weight loss 10 kg, HbA_1c6.9%。

A patient with type 2 diabetes mellitus (T2DM) who was treated in the Department of Endocrinology, the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, was treated with premixed insulin combined with oral hypoglycemic drugs for poor blood glucose control, and was converted to insulin deglutide liraglutide injection combined with oral hypoglycemic drugs, and achieved good results. The patient was a 65-year-old woman diagnosed with T2DM 11 years ago. She was given insulin aspart 30 subcutaneously for 16, 6, and 16 U before three meals, and oral metformin 0.5 g (3 times/d). The self-measured fasting blood glucose (FPG) fluctuated between 7 and 10 mmol/L, and the occasional 2-h postprandial blood glucose (2h-PPG) fluctuated between 11 and 14 mmol/L. Body mass index (BMI) 29.1 kg/m², glycated hemoglobin (HbA_1c) 8.9%, FPG 8.7 mmol/L, 2h-PPG 14.3 mmol/L. The treatment regimen was changed to 16 dose units (once/d) of insulin deglutide injection subcutaneously, 1.0 g of metformin extended-release tablets (twice/d) orally, and the insulin deglutide injection was gradually increased to 26 dose units (once/d) according to the blood glucose level. After 1 month, FPG<7 mmol/L, 2h-PPG<10 mmol/L; At 3-month follow-up, the patient's blood glucose reached the standard, weight decreased by 2 kg, waist circumference decreased by 2 cm, and BMI was 28.3 kg/m², blood pressure 135/85 mmHg (1 mmHg =0.133 kPa), and blood lipid index decreased. The patient had no hypoglycemic reaction and no obvious gastrointestinal reaction.

A patient with type 2 diabetes mellitus (T2DM) with abnormal liver function in the Department of Endocrinology of Hohhot No.1 Hospital was treated with insulin deglutide liraglutide injection. The patient was a 37-year-old male diagnosed with T2DM 6 years ago. Metformin, acarbose, insulin glargine, dulaglutide injection and other drugs have been used to treat poor blood sugar control. Patient BMI 29.7 kg/m², urine routine ketone body 1+, glucose 2+. Alanine aminotransferase (ALT) 225.34 U/L, aspartate aminotransferase (AST) 109.12 U/L, and gamma-glutamyltransferase (gamma-GT) 87.26 U/L. Fasting blood glucose (FPG) 11.24 mmol/L, glycated hemoglobin (HbA_1c) 11.16%, fasting C-peptide 1.78 ng/ml, fasting insulin 5.38 U/ml. Diagnosis was T2DM ketosis, T2DM with poor glycemic control, obesity, fatty liver (severe), elevated transaminases. Diabetic ketosis was corrected by hypoglycemic, keto-eliminating, liquid-rehydrating and liver-protecting treatment. After admission, blood glucose improved significantly after insulin pump therapy, and glucose time within the target range (TIR) increased from 61.9% to 80.9%. After discontinuing the insulin pump, the patient was subcutaneously injected with insulin degluck 30 U before bed, and insulin aspart was subcutaneously injected immediately before meals at 9 U in the morning, 7 U in the afternoon and 7 U in the evening. The patient was discharged from the outpatient clinic for follow-up. In order to simplify the treatment plan, insulin degluc and insulin aspart were stopped after discharge and changed to insulin degluc liraglutide injection 30 dose units (once/d), and the drug dose was downadjusted to 24 dose units (once/d) according to blood glucose level. Blood glucose control was satisfactory, and the results of continuous glucose monitoring showed TIR of 81.7% ~96.5%. The patient had no hypoglycemic reaction and no obvious gastrointestinal reaction. After 10 weeks, the patient returned and lost 2 kg of weight. FPG 6.82 mmol/L, HbA_1c7.0%, ALT 50.93 U/L, ALT 20.02 U/L, γ-GT 41.82 U/L.

Two newly diagnosed patients with type 2 diabetes mellitus (T2DM) in the Department of Endocrinology, Affiliated Hospital of Inner Mongolia Medical University were reported. One patient was initiated with insulin deglutide injection combined with oral medication, and the other patient was switched to insulin deglutide injection combined with oral medication after intensive insulin pump therapy. Later, two patients had stable blood glucose control and gradually stopped all hypoglycemic drugs.

This paper reports the diagnosis and treatment of a patient with type 2 diabetes mellitus (T2DM) who was treated with high-dose insulin combined with metformin and then converted to oral hypoglycemic drugs combined with insulin deglutide liraglutide injection in the Department of Endocrinology, Yucheng District People's Hospital, Ya'an City, Sichuan Province. The patient was a 69-year-old woman who was found to have blood sugar increased for 17 years, polyuria, thirst and polydipsia for 1 week. The treatment with metformin extended-release tablets (0.5 g, 3 times/d) combined with insulin lispro 50 was injected 25, 20, and 25 U before three meals, and the blood glucose control was poor. The patient's blood pressure was 178/90 mmHg (1 mmHg =0.133 kPa) and body mass index (BMI) was 28.04 kg/m²。 Random glucose 20.29 mmol/L, glycated hemoglobin (HbA_1c) was 12.8%. Fasting C-peptide 0.53 nmol/L. According to the patient's medical history and examination, T2DM with poor glycemic control was diagnosed; Diabetic peripheral vasculopathy; Diabetic peripheral neuropathy; diabetic nephropathy; Hypertension grade 3 (very high risk); Arteriosclerosis of both lower limbs with segmental stenosis of left lower limb arteries; Hyperlipidemia. After admission, liraglutide 0.6 mg (once/d) was injected subcutaneously, empagliflozin (10 mg, once/d), and Humalog 50 was injected subcutaneously before three meals, and the dose was gradually reduced. Finally, the optimized hypoglycemic treatment regimen was metformin sustained-release tablets (1.0 g, twice/d), empagliflozin (10 mg, once/d), and insulin degluco liraglutide injection 20 dose units were injected subcutaneously (once/d), and the blood sugar was well controlled and discharged. 6-month follow-up after discharge: weight 63 kg, decrease 10% (7 kg); BMI was 25.24 kg/m²； Fasting blood glucose was 7.2 mmol/L, HbA_1c7.3%。 The patient's blood pressure and blood lipids reached the standard, and there was no hypoglycemia and gastrointestinal adverse reactions.

Two patients with type 2 diabetes mellitus (T2DM) treated in the Department of Endocrinology, Shenyang Fourth People's Hospital of China Medical University were converted to insulin deglutide liraglutide injection due to poor blood glucose control and achieved good results. Case 1 was a 44-year-old female with a 2-year history of T2DM, complicated with chronic complications. Before seeing the doctor, the blood glucose control was not up to standard with long-acting insulin combined with oral hypoglycemic drugs, and the glycosylated hemoglobin (HbA_1c) was 7.3%, and was converted to insulin deglucan liraglutide combined with dapagliflozin 10 mg (once/d) and pioglitazone and metformin 1 tablet each time (twice/d). Dynamic blood glucose monitoring showed that blood glucose was stable and up to standard, and the time of glucose within the target range was>90%, and the complications were relieved and discharged. Case 2 was an 80-year-old woman with a 10-year history of T2DM, coronary heart disease, and poor blood glucose control (HbA_1c9.6%), was given insulin deglutide combined with metformin 500 mg (3 times/d) and acarbose 100 mg (3 times/d). There was a mild gastrointestinal reaction. The dose of insulin deglutide injection was adjusted according to the blood glucose level. No hypoglycemia occurred, and the patient was discharged from hospital with satisfactory blood glucose control.

The diagnosis and treatment process of a newly diagnosed type 2 diabetes mellitus (T2DM) patient in the Department of Endocrinology of Luohu District People's Hospital of Shenzhen was reported. After using subcutaneous insulin pump to intensify hypoglycemic therapy, he was converted to insulin deglutide liraglutide injection combined with oral hypoglycemic drugs. The patient was a 60-year-old male who was diagnosed with T2DM mainly due to dry mouth, polydipsia and polyuria for 3 months. Body weight 96.1 kg, body mass index (BMI) 29.33 kg/m²Glycosylated hemoglobin 13.1%. After admission, the subcutaneous insulin pump was intensive hypoglycemic therapy (basal dose 22 U, large dose 7 U each before three meals), and the insulin dose was adjusted according to the blood glucose detection. After 4 days of treatment, the patient's blood glucose improved significantly compared with before. The subcutaneous insulin pump was stopped, and the subcutaneous injection of insulin deglutide liraglutide injection was changed to 20 dose units (once/night), combined with dapagliflozin 10 mg (once/d) and metformin 0.5 g (three times/d). During the medication, the patient had no gastrointestinal adverse reactions and hypoglycemia, and the blood glucose was well controlled and discharged. After 1 and 3 months of outpatient follow-up, the results of continuous ambulatory blood glucose monitoring showed that the time of glucose within the target range (TIR) was 85.9% after 1 month of discharge; The TIR was 97.2% after 3 months. The patient had no hypoglycemic reaction, no adverse gastrointestinal reactions, improved metabolic indexes, weight loss of 2.5 kg and waist circumference reduction of 6.4 cm.

A 59-year-old female patient with type 2 diabetes mellitus (T2DM) was admitted to the Department of Endocrinology, Baotou Steel Hospital, Inner Mongolia, Department of General Technology Aerospace Medicine. She was admitted to the hospital mainly for dry mouth, polydipsia, polyuria and weight loss for 10 years and aggravation for half a year. The patient was diagnosed with T2DM 10 years ago. He was treated with subcutaneous injection of insulin glargine injection for 13 U (once/d) and insulin aspart injection for 13 U each for breakfast, lunch and dinner. He was admitted to hospital with poor blood sugar control. Body mass index (BMI) 24.2 kg/m², waist circumference 99 cm. Fasting blood glucose 14.64 mmol/L, glycated hemoglobin (HbA_1c）10.3%。 Intensive hypoglycemic therapy with insulin pump, 0.5 g metformin (3 times/d) at the same time, and subcutaneous injection of insulin deglutide liraglutide injection 20 dose units (1 time/d) after discontinuation of insulin pump, blood glucose control was stable, no hypoglycemia occurred, and no obvious gastrointestinal adverse reactions. Follow-up one month after discharge, monitoring peripheral blood glucose fluctuations from 4.6 to 9.7 mmol/L, weight loss of about 2 kg, waist circumference reduced to 95 cm. Follow-up 3 months after discharge, the dose of insulin deglutide liraglutide injection was reduced to 16 dose units (once/d), and the peripheral blood glucose fluctuation was monitored from 5.1 to 9.3 mmol/L, HbA_1c5.6%, and the waist circumference was reduced to 94 cm. There were no adverse gastrointestinal reactions and no hypoglycemia occurred.

The study analyzed the effect of insulin deglucin liraglutide in the treatment of newly diagnosed type 2 diabetes. Thirteen newly diagnosed type 2 diabetes patients admitted to the Department of Endocrinology of Wujin People's Hospital of Changzhou City from June to December 2023 were selected. All patients received intensive insulin therapy for 5 days, and after blood glucose control reached the standard, they were treated with insulin deglutide liraglutide injection combined with oral medication. Blood glucose, glycosylated hemoglobin, hypoglycemia, body mass index, blood lipid, insulin consumption and satisfaction with hypoglycemic regimen were compared before and after treatment. Fasting blood glucose (15.36 ± 2.04) mmol/L, glycosylated hemoglobin (11.9 ± 3.15) %, body mass index (28.98 ± 4.1) kg/m at admission², waist circumference (83.23 ± 7.5) cm. Follow-up at 2 months after discharge, fasting blood glucose (6.9 ± 3.5) mmol/L, glycated hemoglobin (7.6 ± 3.24) %, body mass index (27.4 ± 4.9) kg/m², waist circumference (80.16±6.8) cm, all significantly decreased compared with the previous, and the difference was statistically significant (P<0.05), and no serious hypoglycemic events occurred. The patient had good drug compliance, no obvious gastrointestinal reaction, no additional weight gain, and good overall hypoglycemic effect.