Volume 16 · Issue Z2 · 2024

Diabetic patients can be prone to osteoporosis due to multiple factors. For such patients, glucose control and anti-osteoporosis treatment should be taken into account at the same time. As a new hypoglycemic drug, glucagon-like peptide-1 receptor agonist (GLP-1RA) has shown a gratifying protective effect in important target tissues and organs such as heart, kidney and brain. With further exploration, it is found that it is also effective in the treatment of bone metabolism disorders. It can improve bone density, bone microstructure, regulate bone remodeling, and thereby treat primary and secondary osteoporosis. However, its impact on fracture risk is still controversial. Therefore, this article intends to describe the effects of GLP-1RA on bone health from the aspects of regulating the mechanism of bone metabolism, effects on bone remodeling and bone microstructure, and efficacy in the treatment of osteoporosis and fracture.

To investigate the effect of semaglutide on blood pressure in patients with type 2 diabetes mellitus complicated with hypertension. A total of 100 patients with T2DM complicated with hypertension who were hospitalized in the Department of Endocrinology and Metabolism of the Second Hospital of Lanzhou University from January to June 2022 were selected. According to the patients' intention to treat, they were divided into 50 cases in the control group and 50 cases in the study group. The control group was treated with insulin combined with metformin, and the study group was treated with semaglutide on the basis of the above treatment. The changes of glycosylated hemoglobin and blood pressure between the two groups after 3 months of treatment were compared. The results showed that there were no statistically significant differences in gender, age, duration of diabetes, body weight, body mass index, and glycated hemoglobin at baseline between patients in the study and control groups (P>0.05), which is comparable. After treatment, there was no significant difference in glycosylated hemoglobin levels between the two groups (P>0.05）。 There was no significant change in blood pressure after treatment in the control group compared with that before treatment. However, after treatment with semaglutide, the systolic blood pressure in the study group decreased (5.64±0.92) mmHg (1 mmHg =0.133 kPa) compared with that before treatment, and the difference was statistically significant compared with the control group (P<0.05）； Diastolic blood pressure decreased slightly compared with that before treatment, and the difference was not statistically significant compared with the control group (P>0.05）。 The above results suggest that for patients with T2DM, the new hypoglycemic drug semaglutide can effectively reduce systolic blood pressure while lowering glucose.

The clinical data of 25 obese patients with type 2 diabetes who were hospitalized in the Department of Endocrinology and Metabolism of the Second Hospital of Lanzhou University and treated with semaglutide from March to June 2023 were retrospectively analyzed. Using pairingtThe test assessed body weight, body mass index (BMI), fasting plasma glucose (FPG), 2 h postprandial plasma glucose (2hPG), glycosylated hemoglobin (HbA) before and after 24 weeks of treatment_1c), the steady-state model to evaluate insulin resistance index (HOMA-IR) and the steady-state model to evaluate pancreatic islet β cell function index (HOMA-β), recorded hypoglycemia and other adverse reactions, and performed Spearman correlation analysis on drug dose, blood glucose and body weight, respectively. The results showed that after 24 weeks of treatment, the patient's body weight, BMI, FPG, 2hPG, HbA_1cand HOMA-IR were lower than before treatment (tThe values were 16.95, 24.36, 11.96, 15.05, 16.52 and 11.50, respectivelyP<0.01), HOMA-β was higher than before treatment (t=-2.21，P<0.05）。 Spearman correlation analysis showed that after 24 weeks of treatment, the drug dose was related to FPG (r=-0.433，P=0.031), 2hPG (r=-0.461，P=0.02), HbA_1c（r=-0.484，P=0.014), and there was no significant correlation between drug dose and body weight and BMI (P>0.05）。 Semaglutide can significantly reduce blood sugar and weight in obese T2DM patients, while improving insulin resistance and improving patient compliance.

Retrospective analysis of the diagnosis and treatment process of conversion to semaglutide in a patient hospitalized with acute coronary syndrome and previously complicated with type 2 diabetes mellitus (T2DM) who was treated with insulin and metformin for a long time in the heart center of Tianjin Third Central Hospital. The patient was a 50-year-old male who visited our hospital mainly for "sudden chest pain accompanied by profuse sweating for 5 h". When he arrived at the emergency room of our hospital, the patient's chest pain symptoms persisted without relief, his whole body was damp and cold, his blood pressure was 90/50 mmHg (1 mmHg =0.133 kPa), and his heart rate was 72 beats/min. The patient usually had high blood glucose, intermittently controlled by insulin and oral hypoglycemic drugs, but had poor blood glucose control, and was admitted to hospital to measure glycosylated hemoglobin (HbA_1c) 7.7%, triglycerides 2.9 mmol/L, LDL cholesterol 3.13 mmol/L, HDL cholesterol 0.9 mmol/L, body mass index (BMI) 27.8 kg/m²。 After admission, ECG showed ST segment elevation ≥0.1 mv in II, III and avF leads. Combined with medical history and auxiliary examination, the main diagnosis was acute inferior myocardial infarction, T2DM, and mixed hyperlipidemia. Emergency coronary angiography showed 100% occlusion of the distal right coronary artery, 90% stenosis of the distal circumflex artery, and long lesions in the proximal and middle segment of the anterior descending artery, with the most severe 80% stenosis. First, a stent was implanted in the distal right coronary artery, and 2 weeks later, a stent was implanted in the distal circumflex artery. Postoperatively, prandial insulin combined with oral hypoglycemic drugs was given. After the condition was relatively stable, the regimen was changed to semaglutide 0.25 mg (once/week), metformin sustained-release tablets 1 g (twice/d), dapagliflozin 10 mg (once/d), and the blood glucose was controlled smoothly and the hospital was discharged. After discharge, according to the patient's blood glucose control and tolerance, semaglutide was gradually titrated to 1.0 mg (once/week). At 1 year, the patients' blood pressure, blood glucose and blood lipid were well controlled, with blood pressure 110/75 mmHg, HbA_1c5.7%, triglycerides 1.8 mmol/L, LDL cholesterol 0.68 mmol/L, HDL cholesterol 1.1 mmol/L, BMI 26.1 kg/m²Reexamination of coronary angiography showed no obvious progression of anterior descending artery stenosis, unobstructed stents in circumflex artery and right coronary artery, intimal hyperplasia was not obvious, and the patient's cardiac function recovered well.

Retrospective analysis of a patient with type 2 diabetes who was previously diagnosed as obese in the Department of Endocrinology of Ordos Central Hospital who was treated with dulaglutide and switched to semaglutide combined with oral drug therapy due to gastrointestinal intolerance. The patient was a 56-year-old middle-aged man who was admitted to hospital because he was "found to have high blood sugar for more than 13 years and was weak for half a year". The patient was obese, his blood sugar control was not up to standard, and his compliance was poor. After the previous intensive insulin therapy, he was converted to dulaglutide combined with oral hypoglycemic drugs. After 1 month of treatment, the patient felt obvious nausea, vomiting and diarrhea, so he stopped taking dulaglutide. The glycosylated hemoglobin measured at this admission was 7.7%, combined with carotid plaque and coronary atherosclerosis. He was given semaglutide 0.25 mg, subcutaneous injection once/week and oral hypoglycemic drugs (metformin 0.5 g, twice/d, dapagliflozin tablets 10 mg, once/d), and was discharged after stable blood sugar control. After discharge, the patient's fasting fingertip blood glucose fluctuated from 6.0 to 7.0 mmol/L, and the blood glucose 2 hours after prandial was 7.0 to 9.0 mmol/L. The body weight lost 5 kg in the past 3 weeks, and there was no gastrointestinal discomfort such as nausea and vomiting. The treatment compliance and satisfaction were good.

The diagnosis and treatment of a patient with recurrent hypoglycemia after bariatric metabolic surgery was retrospectively analyzed in the endocrinology department of Beijing Chaoyang Diabetes Hospital. The patient was a 40-year-old male who suffered from hypertension, gout, proteinuria, sleep apnea syndrome, non-alcoholic steatohepatitis, etc. due to glycemic obesity. The treatment effect of liraglutide, dapagliflozin, metformin, insulin, etc. was not good. He underwent bariatric metabolic surgery, and his postoperative weight lost 50 kg. All indexes basically reached the standard. However, he experienced repeated and severe hypoglycemia, obvious hunger, frequent meals and weight gain of 10 kg one year after the operation, which seriously affected the patient's work and life. In this hospitalization, oral glucose tolerance test and islet function test showed: fasting blood glucose 4.49 mmol/L, 2 h postprandial blood glucose 4.34 mmol/L, 3 h postprandial blood glucose 3.91 mmol/L; The fasting insulin was 8.32 mU/L, and the insulin was>300.00 mIU/L at 1 h postprandial, indicating that the peak insulin release was at 1 h, and the secretion amount was too high. The insulin originally decreased from>5 000.0 ng/L to normal. It is considered that the reason may be that the body weight decreased rapidly in a short time after bariatric metabolic surgery, resulting in a great improvement in insulin sensitivity, and the peak secretion was advanced to 1 h postprandial, resulting in preprandial hypoglycemia. After continuous glucose monitoring to understand the regularity of blood glucose fluctuation, the patient was given lifestyle intervention and tried a combination of low-dose semaglutide (0.25 mg, subcutaneous injection once/week) plus acarbose (50 mg/time, 3 times/d with staple food chewing). Good results were achieved. After 1 month of follow-up discharge, there was no severe hypoglycemia. After 3 months, the fasting blood glucose was 6.2 mmol/L, postprandial blood glucose was 7.4 mmol/L, and glycosylated hemoglobin was 6.1%. There was no hypoglycemia. The body weight and metabolic indexes were maintained well, and the patient returned to normal work and life.

To retrospectively analyze the diagnosis and treatment process of improving blood glucose, body weight and other metabolic indexes in an obese type 2 diabetic patient treated with multiple glucagon-like peptide-1 receptor agonists in the Department of Endocrinology, Fuwai Hospital, Chinese Academy of Medical Sciences. The patient was a 55-year-old male who saw the doctor because of "progressive weight gain for 23 years, dry mouth and poly-drinking for 15 years". After completing various examinations, he was clearly diagnosed with "type 2 diabetes, obesity, coronary heart disease, hypertension, hyperlipidemia, sleep apnea-hypopnea syndrome, fatty liver". During the treatment period, the patient changed a variety of glucagon-like peptide-1 receptor agonists (including exenatide, liraglutide, etc.) due to insignificant weight loss and poor compliance, and finally simplified the treatment plan to semaglutide 1 mg (once/week) subcutaneous injection combined with metformin 0.5 g (three times/d). After 1 year of weight loss and hypoglycemic treatment, the glycosylated hemoglobin was 6.3%, the blood sugar control reached the standard, the weight was reduced by 15 kg, the waist circumference was reduced by 11 cm, the blood pressure and blood lipid level were significantly reduced, the coronary artery stenosis was still 50%, the coronary artery disease did not progress, and the islet function did not decrease.

A patient with type 2 diabetes complicated with non-alcoholic fatty liver disease treated with semaglutide combined with metformin in the Department of Endocrinology and Metabolism of Shaoxing People's Hospital was retrospectively analyzed. The patient was a 38-year-old woman who saw a doctor because she "found that her blood sugar had increased for more than 10 years". The patient's fasting blood glucose at the initial visit was 9.54 mmol/L, the postprandial blood glucose at 2 h was 13.98 mmol/L, and the glycosylated hemoglobin (HbA_1c) 7.6%, body mass index (BMI) 38.9 kg/m², waist circumference 112 cm, triglyceride 1.74 mmol/L, total cholesterol 5.79 mmol/L, alanine aminotransferase (ALT) 122.9 U/L, definite diagnosis of "type 2 diabetes, non-alcoholic fatty liver disease", semaglutide 1.0 mg (once/week) combined with metformin 0.5 g (three times/d) treatment. After half a year, the patient lost 32 kg of weight, blood glucose and lipids decreased significantly, and the liver function returned to normal. The follow-up BMI was 26.6 kg/m², waist circumference 84 cm, fasting blood glucose 6.52 mmol/L, 2 h postprandial blood glucose 6.93 mmol/L, HbA_1c6.3%, triglycerides 1.46 mmol/L, total cholesterol 3.62 mmol/L, ALT 27.4 U/L.

A case of type 2 diabetes mellitus diagnosed and treated in the Department of Endocrinology of Beijing Jishuitan Hospital affiliated to Capital Medical University was retrospectively analyzed. After an intolerable gastrointestinal reaction occurred in the treatment with metformin and acarbose, the above drugs were stopped, liraglutide combined with canagliflozin was given to reduce glycemic content, and then the diagnosis and treatment process was switched to semaglutide combined with canagliflozin. The patient was a 60-year-old male who was admitted due to "elevated blood sugar for 12 years and abdominal discomfort for more than 4 months". The patient weighed 107 kg with a body mass index of 35.8 kg/m², glycated hemoglobin 9.4%, 24 h urinary microalbumin 995 mg/24 h. The main diagnoses were "type 2 diabetes, obesity, proteinuria, possible type 2 diabetic nephropathy, hypertension, cerebral infarction, dyslipidemia, multiple atherosclerosis". For the patient's gastrointestinal discomfort, metformin and acarbose were discontinued, and low-dose insulin combined with pioglitazone and canagliflozin were given for treatment. Under close observation, liraglutide was added, and the dose was gradually increased from 0.6 mg (once/d) to 1.8 mg (once/d). The patient had no gastrointestinal discomfort and had good blood glucose control. The post-discharge simplified regimen was semaglutide 1.0 mg (once per week) plus canagliflozin 200 mg (once per day). After 3 months of outpatient follow-up after discharge, the patient had good blood glucose control, no gastrointestinal discomfort, weight 100 kg, glycosylated hemoglobin 6.8%, 24 h urinary microalbumin 170 mg/24 h, the patient was satisfied with the treatment plan.

A patient with congenital adrenocortical hyperplasia combined with obesity type 2 diabetes mellitus treated with semaglutide was retrospectively analyzed in Wenjiang District People's Hospital of Chengdu. The patient was a 30-year-old woman who was admitted to hospital because she "found irregular menstruation for 17 years and increased blood sugar for more than 2 years". 17 years ago, the patient went to the local hospital repeatedly due to irregular menstruation, and was treated with traditional Chinese medicine, progesterone, dyne-35 and other drugs successively. There was no obvious improvement and no further diagnosis and treatment. More than 2 years ago, the patient developed symptoms of dry mouth, polydipsia, and polyuria. The blood glucose was randomly measured at 12 mmol/L. The local hospital diagnosed him with type 2 diabetes. He was given 1 tablet of sitagliptin metformin tablets (50 mg: 850 mg), 2 times/day treatment, and the blood glucose was controlled. More than a year ago, out-of-hospital adrenal CT showed: bilateral adrenal medial and lateral branches were thickened, 17 hydroxyprogesterone and cortisol were significantly decreased, and progesterone, 11 desoxycorticosterone and adrenocorticotropic hormone were increased. Combined with genetic examination, the diagnosis was: congenital adrenocortical hyperplasia 17 α-hydroxylase deficiency non-classical type (CAH-17OHD), compound heterozygous mutation. Dexamethasone 750 μ g was added orally once a day before bedtime, and after 3 months, it was adjusted to dexamethasone 375 μ g orally once a day before bedtime. Six months ago, the patient felt weak, rounded face, accompanied by weight gain, and poor blood sugar control. The regimen was adjusted to subcutaneous injection of semaglutide 0.25 mg (once/week) combined with metformin 850 mg (twice/d), and continued dexamethasone 375 μ g, once before bed. After half a year of follow-up, the glycosylated hemoglobin decreased to 5.2%, the fasting blood glucose was maintained at 5-6 mmol/L, and the blood glucose was maintained at 5-7 mmol/L 2 hours after meal. The body weight was reduced by 24 kg, and the waist circumference was reduced by 15 cm. The patient had no obvious gastrointestinal reactions such as abdominal distension, diarrhea, nausea and vomiting.

This paper reports the diagnosis and treatment of a perimenopausal female diabetic patient with metabolic syndrome admitted to the Department of Endocrinology of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine after intensive therapy with insulin pump, and then converted to semaglutide combined with oral hypoglycemic drugs. The patient was a 51-year-old woman who was admitted to hospital due to "elevated blood glucose for 7 years with poor blood glucose control for half a year". She was overweight, had obvious blood glucose increase, was perimenopausal, and had metabolic syndrome. She had previously used premixed insulin combined with oral drugs for poor blood glucose control. At admission, her glycosylated hemoglobin was measured at 10.7%. After the insulin pump was given to strengthen the hypoglycemic control and the control was stable, the scheme was gradually simplified to semaglutide (starting dose 0.25 mg, once/week, and increased to 0.5 mg, once/week after 2 weeks) combined with metformin (0.5 g, 3 times/d) and dapagliflozin (10 mg, once/d). After the blood glucose control was stable, she was discharged. After 1, 3 and 6 months of outpatient follow-up, fasting blood glucose, 2 h postprandial blood glucose, glycosylated hemoglobin, body weight, waist circumference, blood pressure, blood lipid, uric acid and other metabolic indexes of patients were significantly improved compared with before.

A patient with type 2 diabetes mellitus (T2DM) complicated with mild cognitive impairment (MCI) who was hospitalized in the Department of Endocrinology of East China Hospital affiliated to Fudan University on intensive insulin pump therapy was converted to semaglutide combined with metformin after blood glucose control. The diagnosis and treatment process were reviewed. The patient was a 78-year-old male who was admitted to the hospital because "blood sugar was found to be elevated for 20 years and poorly controlled for 1 month". After admission, all examinations were completed and he was diagnosed with T2DM combined with MCI. Insulin pump was given to reduce glucose. Because the patient was complicated with coronary atherosclerotic heart disease and cognitive decline, the patient was treated with semaglutide combined with metformin after a decrease in blood glucose. After 12 months, it was found that the blood glucose was well controlled and the cognitive function was improved compared with the previous. The patient was satisfied with the treatment effect. Treatment with semaglutide combined with metformin in patients with T2DM combined with MCI can effectively reduce glucose and improve cognitive function.

A case of obese type 2 diabetic patient in Qionglai Medical Center Hospital was reported. After insulin glargine combined with liraglutide enhanced hypoglycemic therapy, the diagnosis and treatment process was converted to semaglutide maintenance therapy. The patient was a 56-year-old male diagnosed with type 2 diabetes for nearly 1 year. He took metformin hydrochloride sustained-release tablets 0.5 g 3 times/d for a long time, with poor blood glucose control. Recently, his fasting blood glucose was 8.5 mmol/L, and his glycosylated hemoglobin was 7.9%. This visit, body mass index 29.4 kg/m²After improving the relevant examinations, the diagnosis was: type 2 diabetes with poor blood sugar control and obesity. In order to correct the hyperglycemic state in the patient as soon as possible and prevent the acute complications of diabetes, we added insulin glargine and liraglutide to the patient on the basis of metformin 0.5 g, 3 times/d, and adjusted the injection dose according to the blood glucose in real time. After 1 week, the dose of insulin glargine was 24 U, once/night, the dose of liraglutide was 1.8 mg, once/morning, and the fasting blood glucose<7.0 mmol/L, 2 h postprandial blood glucose<10.0 mmol/L, blood glucose was well controlled, improved and discharged. After discharge, because the blood glucose control was ideal, the patient adjusted the drug dose by himself. At the follow-up visit one month later, the patient's hypoglycemic regimen was adjusted to metformin 0.5 g, twice/d, combined with semaglutide 1.0 mg, once/week, and the blood glucose was still well controlled. The fasting blood glucose was 6.9 mmol/L, and the blood glucose 2 hours after breakfast was 9.4 mmol/L. No adverse reactions such as hypoglycemia were complained.

The problem of obesity is becoming increasingly severe, which seriously affects human health. Weight-loss drugs are an important choice to control weight on the basis of improving lifestyle. The specific mechanism, effect and adverse reactions need to be fully understood. Semaglutide was first used in clinic as a hypoglycemic drug. With the emergence of more and more evidence-based evidence, its weight loss effect has become increasingly prominent. This article focuses on reviewing recent studies on the weight loss effect of semaglutide. Among people with type 2 diabetes, non-diabetic overweight, and obesity, semaglutide has shown excellent weight loss effects regardless of once-a-week injection form or once-a-day oral dosage form, effectively improving cardiovascular outcomes in obese patients, providing more choices for obesity management.

Glucagon-like peptide-1 (GLP-1) has the effects of regulating insulin level, controlling blood glucose and regulating feeding behavior. GLP-1 receptor agonist (GLP-1RA), as a GLP-1 analog, is currently widely used in blood glucose control in patients with type 2 diabetes and weight loss treatment in obese patients. Recent studies have shown that GLP-1RA shows neuroprotective and antidepressant properties, and plays a regulatory role in the immune, endocrine and metabolic processes of the central nervous system. The purpose of this paper is to explore the potential antidepressant effects of GLP-1RA in order to provide reference for clinical practice.

The prevalence of diabetes is on the rise worldwide. In China, the prevalence of diabetes is also rising. At present, the prevalence of adult diabetes is about 12.8%, while the prevalence of pre-diabetes is as high as about 35%. This data reflects the huge scale of pre-diabetic population in China. Prediabetes is a reversible process, and the risk of diabetes can be reduced by early individualized, diversified and comprehensive intervention. Lifestyle intervention is the preferred treatment for prediabetes, and pharmacological intervention may be considered when lifestyle intervention does not achieve the desired goals. This article reviews the mechanism of action, clinical application and safety of glucagon-like peptide-1 (GLP-1) receptor agonists, and explores their application prospects and future research directions in prediabetic patients, especially in those patients who respond poorly to lifestyle changes or need additional support to improve glycemic control and lose weight, GLP-1 receptor agonists may be an effective treatment option.

In the treatment of type 2 diabetes mellitus (T2DM), glucagon-like peptide-1 receptor agonists (GLP-1RA) play an important role. GLP-1RA is a new type of hypoglycemic drug in recent years. By activating glucagon-like peptide-1 receptor, it enhances insulin secretion in a glucose concentration-dependent way, inhibits glucagon secretion, and can delay gastric emptying. Reduce food intake through central appetite suppression, thereby achieving the effects of reducing blood sugar and weight. This article summarizes the multiple benefits of GLP-1RA in the treatment of T2DM.

Diabetic nephropathy (DKD) is the leading cause of end-stage kidney disease (ESRD) worldwide. Glucagon-like peptide-1 receptor agonist (GLP-1RA) is currently widely used in the treatment of clinical patients with type 2 diabetes mellitus (T2DM). A series of clinical and experimental studies have shown that the beneficial effect of GLP-1RA on DKD is mediated by urinary sodium excretion, anti-inflammatory and anti-oxidative stress, independent of the hypoglycemic ability. Furthermore, GLP-1RA has been shown to inhibit renal fibrosis. Recent clinical trials have shown that GLP-1RA has a beneficial effect on renal outcomes, particularly in patients with T2DM at high risk for cardiovascular disease. These findings suggest that GLP-1RA has great promise in preventing and controlling the occurrence and progression of DKD. However, GLP-1RA has only been shown to reduce albuminuria, and its ability to reduce ESRD progression remains to be elucidated. This article focuses on reviewing current understanding of the clinical efficacy of GLP-1RA in DKD and its mechanism of action.