Investigation Of Exendin-4 Therapy For Type 2 Diabetes And Metabolic Syndrome

Objective: To investigate the effect of exendin-4 in the treatment of type 2 diabetes and type 2 diabetes with metabolic syndrome.Methods: Altogether 271 type 2 diabetes patients (age 18-70 years, duration half to 10 years) were enrolled. All the patients was randomized to receive exendin-4 5ug by injection (group A) ,exendin-4 10ug by injection (group B) or placebo (group C) on the basis of the treatment for 12 weeks. Blood was drawn regularly to determine fasting plasma glucose and insulin, 2h postprandial blood glucose, glycosylated hemoglobin (HbAlc) and serum lipid profiles.According to the definition of metabolic syndrome by CDS, all the subjects were divided into Group 1 ( type 2 diabetes with metabolic syndrome group) and Group 2 (type 2 diabetes group). Thus the subjects were divided into six subgroups: subgroup Al (type 2 diabetes with metabolic syndrome group with exendin-4 5ug, n=34), subgroup A2 (type 2diabetes group with exendin-4 5ug, n=49), subgroup B1 (type 2 diabetes with metabolic syndrome group with exendin-4 10ug, n=39); subgroup B2 (type 2 diabetes group with exendin-4 10ug, n=55), subgroup C1 (type 2 diabetes with metabolic syndrome group with placebo, n=41) and subgroup C2 (type 2 diabetes group with placebo, n=53). According to the BMI>25kg/m~2 or not ,all the subjects of group A and B were divided into subgroup of obesity and subgroup of non-obesity group;and according to the BMI>28kg/m~2 or not all the subjects with metabolic syndrome of group A and B were divided into subgroup of obesity metabolic syndrome and subgroup of non- obesity metabolic syndrome.Results: (1) Totally there were 237 patients completed the 14-weeks observation. The number of patients who had completed the observation in A1 , B1, C1 , A2 , B2 and C2 subgroups was 30,30,33,47,49 and 48 respectively.(2) After with exendin-4 for 12 weeks, the decreases in HbAlc of both group A and B were larger than subgroup C (P<0.05), and the level of 2hPBS decreased significantly both in group A and B compared with the baseline respectively (all P<0.05) but not subgroup C; The level of TC decreased significantly in group A compared with the baseline (P<0.05) but not group C;And the decreases in LDL-C of group A was larger than group C (P<0.05). the level of DBP decreased significantly both in group A and B compared with the baseline respectively (all P<0.05) but not group C; and the level of HOMA-IR decreased significantly in group B compared with the baseline (P<0.05) but not group A and C.(3) Compared with the baseline, the level of 2hPBS decreased significantly (P<0.05) in subgroup A1 but not subgroup A2; compared with the baseline, the level of BMI decreased significantly (P<0.05) in subgroup B1 but not subgroup B2;(4) The the levels of SBP, DBP, BMI,FBS, 2hPBS, TC ,HbAlC and HOMA-IR all decreased significantly (P<0.05) in subgroup of obese compared with the baseline,and only the levels of DBP, FBS, TC ,HbAlC and HOMA-IR decreased signifieantly (P<0.05) in subgroup of non obese compared with the baseline. And the decreases in 2hPBS and HOMA-IR in subgroup of obese were larger than of non obese (P<0.05),(5) The the levels of SBP, DBP, BMI,FBS,HDL-C,HbAlc are all decreased significantly (P < 0.05) in subgroup of obese metabolic symdrome compared with the baseline, but only the levels of, BMI,FBS, HOMA-IR and HbAlc decreased signifieantly (P<0.05) in subgroup of non- obesity metabolic syndrome compared with the baseline. And the decreases in SBP of subgroup of obese metabolic syndrome was larger than subgroup of non- obesity metabolic syndrome (P<0.05)Conclusion: Exendin-4 improve the blood glucose,lipid,blood pressure,and hold back obesity and insulin resistance. And the effects are more visible in type 2 diabetes patients with metabolic syndrome than type 2 diabetes patients without metabolic syndrome .The effects are more visible in obese type 2 diabetes patients than non-obese type 2 diabetes patients. The the effects of decreasing the blood pressure are more visible in obese metabolic syndrome patients than non- obesity metabolic syndrome patients.