To observe clinical efficacy and safety of low-dose sitagliptin tablets combined with dapagliflozin tablets in the treatment of elderly patients with diabetic kidney disease (DKD).

According to random number table method, elderly patients with DKD admitted to the hospital were divided into group A (low-dose sitagliptin tables, 50 mg qd), group B (dapagliflozin tables, 10 mg qd) and group C (low-dose sitagliptin tables, 50 mg qd combined with dapagliflozin tables,10 mg qd). All patients were treated for 3 months. The clinical curative effect and changes in fasting blood glucose (FBG), 2 h postprandial blood glucose (2 h PG), glycosylated hemoglobin (HbA1c), estimated glomerular filtration rate (eGFR), serum creatinine (SCr), blood urea nitrogen (BUN), uric acid (UA), monocyte chemoattractant protein-1 (MCP-1), adiponectin (APN), nuclear factor-κB (NF-κB) and urinary albumin creatinine ratio (UACR) were compared among the three groups, and the safety evaluation was performed.

In this study, there was no shedding cases. Among the 129 patients, there were 43 cases in group A, 43 cases in group B and 43 cases in group C. After treatment, response rate of group C was 95.35% (41 cases /43 cases), which was significantly higher than that of group A [79.07% (34 cases /43 cases)] and group B [81.40% (35/43 cases)] (all P<0.05). After treatment, HbA1c levels in group A, group B and group C were (7.17±1.21)%, (6.64±1.06)% and (6.13±1.14)%; SCr levels were (94.37±12.16), (86.19±11.45) and (80.45±10.37) μmol·L^-1; and UACR were (80.04±8.36), (71.19±7.72) and (53.04±6.81) mg·g^-1, respectively. Compared with group A, the above indexes were statistically significantly decreased in group B and group C, and which were statistically significantly lower in group C than group B (all P<0.05). After treatment, eGFR in group A, group B and group C were (81.50±9.12), (92.41±9.56) and (103.73±10.24) mL·min^-1 · 1.73 m^-2, respectively. Compared with group A, eGFR was statistically significantly increased in group B and group C, and which was statistically significantly higher in group C than group B (P<0.05). After treatment, MCP-1 levels in group A, group B and group C were (85.38±8.42), (91.40±9.28) and (73.12±8.06) pg·mL^-1; NF-κB levels were (4.09±1.08), (4.71±1.22) and (3.52±0.85) ng·mL^-1, respectively. Compared with group B, the above indexes were statistically significantly decreased in group A and group C, and which were statistically significantly lower in group C than group A (both P<0.05). After treatment, APN levels in group A, group B and group C were (10.17±2.06), (9.15±1.50) and (11.24±2.17) pg·mL^-1, respectively. Compared with group B, APN was statistically significantly increased in group A and group C, and which was statistically significantly higher in group C than group A (P<0.05). The main adverse drug reactions in group A were gastrointestinal discomfort and nasopharyngitis; in group B were gastrointestinal discomfort, hypotension and urinary and reproductive system infection, and in group C were hypoglycemia and gastrointestinal discomfort. There was no significant difference in total incidence of adverse drug reactions among group A, group B and group C (30.23% vs. 20.93% vs. 27.91%, all P>0.05). Pearson correlation analysis showed that decrease of UACR after treatment was positively correlated with the decrease of NF-Κb and MCP-1 and the increase of APN (r=0.419, 0.524, 0.485, all P<0.05).

There is a synergistic effect of low-dose sitagliptin combined with dapagliflozin in the treatment of elderly patients with DKD, which can significantly improve blood glucose metabolism indexes, enhance renal function, regulate levels of inflammatory factors and effectively reduce UACR, with good safety.