Abstract: Objective To evaluate the therapeutic effects of dulaglutide in combination with a ketogenic diet in the management of elderly patients with type 2 diabetes mellitus (T2DM) complicated with non-alcoholic fatty liver disease (NAFLD). Methods From February 2021 to February 2023, 94 patients with T2DM and NAFLD were enrolled in this study. Participants were randomly assigned to two groups: by random draw, the control group (n=47), receiving insulin and a ketogenic diet, and the observation group (n=47), treated with dulaglutide and a ketogenic diet. Clinical efficacy was assessed by comparing pre- and post-treatment levels of blood glucose, lipids, liver function, and oxidative stress markers between the two groups. Additionally, the incidence of adverse reactions was monitored. Results Post-treatment, the efficacy rate in the observation group was 97.87%, significantly higher than in the control group (82.98%). The observation group demonstrated significantly lower levels of fasting blood glucose(FBG) (6.10±1.22), 2-hour postprandial blood glucose(2hPBG) (8.21±1.75), and HbA1c (6.21±1.25) compared to the control group (7.35±1.58, 10.23±2.06, 7.69±1.58, respectively). Lipid levels, including total cholesterol(TC) (3.22±0.87) and TG (1.22±0.21) were also lower in the observation group compared to the control group (4.69±1.01 and 2.15±0.57, respectively). Liver function markers such as AST (23.54±3.59), ALT (41.32±4.76), and GGT (31.62±4.01) were significantly reduced in the observation group compared to the control group (32.78±4.27, 52.36±6.02, and 49.86±5.75, respectively). Additionally, oxidative stress markers,including MDA (642.51±90.27) and 8-iso-PGF2α (125.35±11.05), were lower, while GSH-Px (151.21±15.67) was higher in the observation group compared to the control group (724.25±95.21, 142.58±11.47, and 120.52±12.58, respectively), with all differences being statistically significant (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion The combination of dulaglutide and a ketogenic diet significantly improves clinical outcomes in elderly patients with T2DM and NAFLD, effectively reducing blood sugar and lipid levels, enhancing liver function, and mitigating oxidative stress responses compared to insulin combined with a ketogenic diet, while maintaining a comparable safety profile.

Key words: Dulaglutide, Ketogenic diet, Elderly type 2 diabetes mellitus, Non-alcoholic fatty liver disease