利拉鲁肽对超重及肥胖2型糖尿病患者体质量和胰岛素抵抗的影响

Effects of liraglutide on insulin resistance and body mass in overweight and obese patients with type 2 diabetes

目的观察利拉鲁肽对超重及肥胖2型糖尿病患者体质量和胰岛素抵抗的影响。方法选取安徽医科大学第二附属医院2012年6月至2014年1月住院治疗的2型糖尿病患者,将口服药物血糖控制不佳且体质量指数(BMI)≥24 kg/m2的90例2型糖尿病患者按系统随机化法分成治疗组(45例)和对照组(45例),对照组在原方案上加用基础胰岛素,治疗组加用利拉鲁肽,治疗组根据BMI进一步分为超重亚组(BMI<28 kg/m^2)24例,和肥胖亚组(BMI≥28 kg/m^2)21例,连续治疗12周。比较治疗后各项指标(BMI、收缩压、空腹血糖、餐后血糖等)变化。结果治疗组BMI及稳态模型胰岛素抵抗指数(HOMA-IR)治疗后较治疗前显著降低(P<0.05),对照组治疗后增加(P<0.05);收缩压(SBP)、空腹血糖(FBG)、餐后2 h血糖(2 h PG)、糖基化血红蛋白(HbA1C)、三酰甘油(TG)、总胆固醇(TCH)在两组中均较前下降(P<0.05),治疗组SBP、TG、TCH下降优于对照组(P<0.05),FBG、2 h PG、HbA1C下降,组间差异无统计学意义(P>0.05);治疗组中肥胖亚组BMI下降程度优于超重亚组(P<0.05);治疗过程中两组均未发生严重低血糖。结论利拉鲁肽在降糖的同时也可以降低患者体质量并改善患者胰岛素抵抗;随着BMI增加,利拉鲁肽降低体质量及改善胰岛素抵抗作用越强。

Objective To observe the effects of liraglutide on body mass and insulin resistance in the overweight and obese patients with type 2 diabetes. Methods From Jun 2012 to Jan 2014, ninety cases of patients with type 2 diabetes hospitalized in our hospital, which were poorly controlled by oral hypoglycemic drugs with body mass index （BMI） ≥24 kg/m2, were divided into the treatment group （45 ca-ses） and the control group （45 cases） by randomized system. The treatment group was further divided into two subgroups according to their BMIs：the overweight subgroup （BMI 〈 28 kg/m2, 24 cases） and the obese subgroup （BMI≥28 kg/m2, 21 cases）. Besides the original therapy regimen, the control group was given basal insulin and the treatment group with liraglutide, lasting for 12 weeks. After treatment, the changes of such indicators （ BMI, systolic blood pressure, fasting blood glucose, postprandial blood glucose, etc. ） between them were com-pared. Results In the treatment group, the results of BMI and homeostasis model assessment of insulin resistance （ HOMA-IR） were sig-nificantly fewer after treatment than those before treatment （P〈0. 05）, but these results in the control group were significantly increased after treatment （P〈0. 05）. The levels of systolic blood pressure （SBP）, fasting blood glucose （FPG）, 2-hour postprandial glucose （2hPG）, glycosylated hemoglobin （HbA1c）, triglyceride （TG） and total cholesterol （TCh） decreased significantly in both groups after treatment （all P〈0. 05）, and there were significant differences in the decline of SBP, TG and TCh levels between the two groups （P〈0. 05）, but no sig-nificant difference was found in the decline of FPG, 2hPG and HbA1c between the two groups （P〉0. 05）. In the treatment group, BMI of the obese subgroup dropped more significantly than that of the overweight subgroup （ P〈0. 05 ） . There was no severe hypoglycemia in both groups during treatment. Conclusion For those overweight and obese patients with type 2 diabetes, liraglutide could play an important role in reducing blood glucose, and further decreasing their body mass and improving their insulin resistance. And when the baseline BMI is high-er, the effects of liraglutide in decreasing body mass and improving insulin resistance would be stronger.