Abstract
OBJECTIVE: To investigate the effects of canagliflozin combined with metformin on insulin sensitivity in patients with type 2 diabetes mellitus (T2DM). METHODS: Patients with T2DM who were treated in the outpatient department of the hospital between May 2023 and May 2024 were selected. Based on different treatment approaches, the patients were divided into a control group (80 cases) and an observation group (80 cases). The control group received metformin treatment, while the observation group was treated with a combination of canagliflozin and metformin. All patients underwent a six-month course of drug treatment. Indicators related to blood glucose control, such as fasting blood glucose (FBG), 2 h postprandial blood glucose (2hPG), and glycosylated hemoglobin (HbA1c), were measured before and after treatment. Pancreatic function indicators, including fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR), beta-cell function (HOMA-β), and insulin sensitivity (HOMA-ISI), were also evaluated. Changes in total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), waist circumference, and body mass index (BMI) before and after treatment were compared between the two groups. Adverse reactions during the treatment period were recorded for both groups. RESULTS: After treatment, HbA1c, FPG, and 2hPG levels in both groups were lower than their respective pre-treatment levels, with the observation group showing significantly lower levels than the control group (P < 0.05). Post-treatment FINS, HOMA-β, and HOMA-ISI levels in both groups were higher than pre-treatment levels, with the observation group exhibiting significantly higher levels than the control group (P < 0.05). HOMA-IR levels in both groups decreased compared to pre-treatment levels, with the observation group demonstrating significantly lower levels than the control group (P < 0.05). Total cholesterol (TC), triglycerides (TG), LDL-C, BMI, and waist circumference in both groups decreased after treatment, with the observation group displaying greater reductions than the control group (P < 0.05). HDL-C levels increased in both groups after treatment, with the observation group achieving higher levels than the control group (P < 0.05). The extent of improvement in patients' HbA1c, TC, BMI, and waist circumference was significantly correlated with changes in HOMA-IR (P < 0.05). Additionally, improvements in HbA1c, BMI, and waist circumference were significantly associated with changes in HOMA-β (P < 0.05). No significant difference was observed in the overall incidence of adverse reactions between the two groups (10.00% vs. 15.00%, P > 0.05). CONCLUSION: The combination of canagliflozin and metformin in the treatment of T2DM not only effectively reduces blood glucose levels but also significantly improves insulin sensitivity and pancreatic function, with good safety profiles. For T2DM patients with obesity or insulin resistance, the combination therapy may offer additional benefits in terms of weight management and enhanced insulin sensitivity.