Objective To compare the effectiveness and safety of semaglutide with dulaglutide in patients diagnosed with type 2 diabetes.Methods A multicenter retrospective cohort study was conducted to include patients with type 2 diabetes who received semaglutide or dulaglutide treatment at three hospitals between April 2021 and July 2023 in the study.The patients were divided into the semaglutide group(SEMA group)and the dulaglutide group(DULA group)based on their treatment.Propensity score matching was used to pair the two groups in a 1:1 ratio,aligning them based on baseline characteristics such as gender,age,body mass index,blood glucose levels,duration of diabetes,and complications.Various parameters including fasting blood glucose,2-hour postprandial blood glucose,glycosylated hemoglobin(HbA1c),serum creatinine,urea nitrogen levels,estimated glomerular filtration rate(eGFR),urinary albumin/creatinine ratio(UACR),and occurrences of adverse reactions were assessed at 3,6,9,and 12 months after the treatment.Results After propensity score matching,98 patients were included in both the SEMA and DULA groups,showing no statistically significant differences in baseline characteristics between the groups(P＞0.05).At each follow-up point,the fasting blood glucose,2-hour postprandial blood glucose,and HbA1c levels of both groups showed a significant decrease compared to the baseline(P≤0.05).The inter-group comparison revealed no statistically significant differences in the changes in fasting blood glucose,2-hour postprandial blood glucose,and HbA1c levels between the two groups(P＞0.05).At the 6th month,the SEMA group exhibited a statistically significant higher rate of HbA1c＜7％compared to the DULA group(P＜0.05).In the SEMA group,serum creatinine and urea nitrogen decreased significantly at the 6th month compared to baseline,while eGFR showed an increase at the 3rd and 6th month,and UACR decreased,all with statistical significance(P＜0.05).In the DULA group,there was a statistically significant increase in serum creatinine and decrease at the 3rd and 6th months in eGFR,respectively.Additionally,urea nitrogen levels decreased significantly at the 9th month,all differences were statistically significant(P＜0.05).The inter-group comparison revealed that at the 3rd and 6th month,the SEMA group exhibited a greater reduction in serum creatinine levels compared to the DULA group.Additionally,the SEMA group demonstrated a more pronounced increase in eGFR levels than the DULA group,with statistical significance(P＜0.05).At the 6th month,the SEMA group exhibited a significantly greater decrease in UACR and a significantly lower incidence of renal insufficiency compared to the DULA group(P＜0.05).There were no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Semaglutide and dulaglutide can significantly improve blood glucose control,exhibit comparable effectiveness and safety in lowering blood glucose levels,and semaglutide has a potentially protective effect on renal function.

Objective To explore the distribution characteristics and regularity of traditional Chinese medical (TCM) syndromes in patients with sepsis in Department of Emergency of our hospital by enalyzed their clinical data and TCM four clinical diagnostic information so as to provide the basis for TCM standardized diagnosis and treatment of sepsis. Methods From July 2016 to October 2017, 135 patients with sepsis were admitted to the Department of Emergency and Department of Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of Zhejiang Chinese Medical University, 110 cases in sepsis group, 25 cases in sepsis shock group. An unified questionnaire was developed to collect the patients' general data, infection site and TCM four clinical diagnostic information (TCM syndromes, tongue coating, pulse signs, etc.) for dialectical typing on the day of admission with definite diagnosis, the relevant laboratory examinations were completed within 24 hours after the confirmative diagnosis was made, and the quick sequential organ failure assessment (qSOFA) and SOFA scores were calculated. Results In 135 cases of sepsis, pulmonary infection (51.9%) was the main one, followed by abdominal infection (25.9%). The distribution of TCM syndromes: the toxic heat syndrome was the main syndrome in sepsis group (61.8%) and acute deficiency syndrome was the main syndrome in sepsis shock group (68.0%), the difference between the two groups being statistically significant (P < 0.001). There were no statistical significant differences in comparisons of infection related indicators between sepsis and septic shock groups, different TCM syndromes of sepsis (all P > 0.05), such as white blood cell count (WBC), percentage and absolute value of neutrophils, C-reactive protein (CRP), procalcitonin (PCT). the lactic acid in patients of the acute deficiency syndrome was significantly higher than those in patients of the toxic heat syndrome, the stoppage of the qi of the bowels syndrome and blood stasis syndrome [mmol/L: 2.8 (1.5, 4.2) vs. 1.3 (1.0, 1.8), 1.6 (1.3, 3.8), 1.6 (1.2, 2.9), P < 0.001], and in septic shock group was significantly higher than that in the sepsis group [mmol/L: 4.0 (2.7, 5.7) vs. 1.4 (1.1, 1.9), P = 0.000]. The rate of qSOFA ≥ 2 score was 25.5% (28/110) in sepsis group, and 80.0% (20/25) in sepsis shock group, the difference being statistically significant (P < 0.001); while the rate of qSOFA ≥ 2 score was 69.4% (25/36) in patients of acute deficiency syndrome, 42.1% (8/19) in patients of the stoppage of the qi of the bowels syndrome, 19.1% (13/68) in patients of toxic heat syndrome and 16.7% (2/12) in patients of blood stasis syndrome, the differences also being statistically significant (all P < 0.001). The scores of SOFA in septic shock group [7.0 (5.0, 10.0)] and acute deficiency syndrome group [6.0 (4.0, 9.0)] were significantly higher compared with those in sepsis group [3.0 (2.0, 4.0)] and other syndrome types patients [toxic heat syndrome 3.0 (2.0, 4.0), the stoppage of the qi of the bowels syndrome 4.0 (2.0, 6.0) and blood stasis syndrome 4.5 (3.0, 5.0)], the differences being statistically significant (all P < 0.001). Conclusions The distribution of TCM syndromes of sepsis is related to the severity degree of sepsis, in TCM dialectical typing of sepsis, from toxic heat syndrome developing into the stoppage of the qi of the bowels syndrome, and from blood stasis syndrome to acute deficiency syndrome, the SOFA score and lactic acid level were gradually increased as the disease condition was continuously aggravating, so the SOFA score and lactic acid could be used as the reference indicators for the severity degree of sepsis; in septic patients with different TCM syndromes, the rates of qSOFA ≥ 2 were different, and the qSOFA score combined with patient's TCM syndrome can enhance the early diagnosis of sepsis.