利拉鲁肽联合二甲双胍在超重或肥胖2型糖尿病患者中的减重疗效及其影响因素

Effect of liraglutide combined with metformin on weight loss in overweight or obese patients with type 2 diabetes and the influencing factors

目的探索利拉鲁肽联合二甲双胍治疗超重或肥胖2型糖尿病(type 2 diabetes mellitus,T2DM)患者的疗效及安全性,分析其减重特点及影响因素。方法筛选二甲双胍治疗的超重或肥胖T2DM患者73例,在二甲双胍1500 mg/d的基础上联合利拉鲁肽1.8 mg/d治疗48周,治疗前后测定血糖、糖化血红蛋白、空腹胰岛素、血脂、体重、腰围、臀围等,计算体重指数、胰岛β细胞功能指数、胰岛素抵抗指数等,观察患者的代谢指标变化及不良反应发生率,评估患者减重效果及其影响因素。结果加用利拉鲁肽治疗48周后,患者空腹血糖、餐后2小时血糖、糖化血红蛋白、空腹胰岛素、胰岛素抵抗指数、血脂、体重、体重指数、腰围、臀围均较基线明显下降(P<0.05),不良反应以胃肠道反应为主,大多可耐受。治疗4周时体重平均下降3.99 kg,占体重下降总幅度的48.8%,此后体重下降逐渐趋缓,治疗48周后,73.1%、34.6%的患者体重分别下降了5%及10%以上;体重下降的绝对值与基线体重呈正相关,治疗起始4周内体重下降幅度是治疗48周时减重是否成功的独立预测因素。结论利拉鲁肽联合二甲双胍治疗超重或肥胖T2DM患者安全、有效,减重效果良好,起始用药4周内的减重效果最为显著,且可以预测其远期减重效果。

Objective To investigate the efficacy and safety of liraglutide combined with metformin in the treatment of overweight or obese patients with type 2 diabetes,and to analyze the factors influencing the response to liraglutide.Methods Seventy-three overweight or obese patients with well-controlled type 2 diabetes on metformin were selected and treated with liraglutide at 1.8 mg/d in addition to metformin at 1500 mg/d for 48 weeks.Relevant data were collected before and after treatment,including blood glucose,glycosylated hemoglobin(HbA1c),fasting insulin,serum lipid,body weight,waist circumference,hip circumference,body mass index(BMI),homeostatic model assessment forβ-cell function(HOMA-β)and homeostatic model assessment for insulin resistance(HOMA-IR).Changes in metabolic markers,incidence of side effects,weight loss efficacy and corresponding influencing factors were evaluated.Results After 48 weeks of treatment,fasting blood glucose,2-hour postprandial blood glucose,HbA1c,fasting insulin,HOMA-IR,blood lipid,waist circumference,hip circumference and BMI decreased significantly compared with baseline(P<0.05).The most common side effects were tolerable gastrointestinal adverse events.The average weight loss after the initial 4-week treatment was 3.99 kg,accounting for 48.8%of the total weight loss,and then the change displayed a more subdued trend during the remaining treatment period.After the 48-week treatment,73.1%and 34.6%of the patients lost more than 5%and 10%of body weight,respectively.Absolute weight loss was positively correlated with baseline weight and weight loss within the initial 4-week treatment was an independent predictor of weight loss≥5%at the 48th week.Conclusions Liraglutide combined with metformin is safe and effective in the treatment of overweight or obese patients with type 2 diabetes mellitus.Weight loss is significant during the initial 4 weeks and the early response seems to be a predictor for better long-term effect on weight loss.