| Objective: 1.To investigate the characteristics of lipid metabolism,bone metabolism and inflammation factors in type 2 diabetes mellitus(T2DM)patients with obesity or overweight.2.To analyze the effects of Liraglutide on lipid metabolism,bone metabolism and inflammation factors in T2 DM patients with obesity or overweight,and compared with Insulin aspart 30 to explore the clinical application value of Liraglutide.Method: 1.Case collection and grouping: according to the inclusion and exclusion standard,81 cases of T2 DM patients with obesity or overweight who unable to achieve glycemic control with metformin in the department of endocrinology in the First Affiliated Hospital of Anhui Medical University during March 2013 to June 2015 were selected as research object,and were randomly divided into 2 groups.43 cases were received Liraglutide and metformin therapy(Liraglutide group,n=43),and 38 cases were received Insulin aspart 30 and metformin therapy(Insulin aspart 30 group,n=38).The control targets of fasting blood glucose,2h postprandial blood glucose and glycosylated hemoglobin were set as 4.4-7.0 mmol/L,less than 10.0 mmol/L and less than 7.0%.The two groups received consecutive treatment for 26 weeks.General information and biochemical indices,lipid metabolism,bone metabolism and inflammation factors were recorded before treatment,14 weeks and 26 weeks after treatment,than compared.85 normal cases were selected as normal control group(NC group).2.General information and biochemical indices: medical history and situation of medication were inquired,blood pressure,weight,waist circumference,hip circumference,hepatic and renal function,blood glucose,glycosuria hemoglobin(Hb A1c),fasting insulin(FINS),serum lipid were detected,and body mass index(BMI),waist hip ratio(WHR)were calculated,and adverse effects were recorded.3.Lipid metabolism indices: fat content,fat percentage and muscle content were measured by dual-energy x-rays absorptiometry(DXA).Fibroblast growth factors 21(FGF21)as adipocytokines,Irisin as muscle factor were measured by enzyme linked immunosorbent assay(ELISA).4.Bone metabolism indices: total bone mineral density(BMD)was measured by DXA.N-MID-osteocalcin(N-MID-OT)as bone formation marker,β-carboxy telopeptide of type I collagen(β-CTX)as bone resorption markers were measured by ELISA.5.Inflammation factors: tumor necrosis factor–α(TNF-α),Interleukin-1(IL-1)were measured by ELISA.Main outcome measures: fat content,fat percentage,muscle content,FGF21,Irisin,BMD,N-MID-OT,β-CTX,TNF-α,IL-1.Secondary outcome measures: blood pressure,FBG,P2 h BG,Hb A1 c,weight,BMI,waist circumference,WHR,TC,TG,HDL-C,LDL-C.Result: 1.The change of general information and biochemical indices,lipid metabolism,bone metabolism and inflammation factors in T2 DM patients with obesity or overweight: compared to NC group,BP,weight,BMI,waist circumference,hip circumference,WHR,FBG,Hb A1 c,TC,TG,LDL-C of T2 DM patients with obesity or overweight were all higher(P<0.05),and HDL-C was lower(P<0.05).Bone metabolism and inflammation factors,fat content,fat percentage,muscle content,FGF21,β-CTX,TNF-α,IL-1 were all higher(P<0.05),and BMD,Irisin,N-MID-OT were all lower(P<0.05).2.The change of general information and biochemical indices before and after treatment between Liraglutide and Insulin aspart 30 groups: the general information and biochemical indices before treatment had no statistically significant differences(P>0.05),with comparability.Compared to pre-treatment,blood pressure,weight,BMI,waist circumference,FBG,P2 h BG,Hb A1 c,TC,TG,FINS and IR after 14-week treatment in Liraglutide group were significantly decreased(P<0.05).Blood pressure,weight,BMI,waist circumference,FBG,P2 h BG,Hb A1 c,TC,TG,FINS,IR and LDL-C after 26-week treatment in Liraglutide group were significantly decreased(P<0.05).Compared to 14-week treatment,waist circumference,WHR,FBG,P2 h BG,TC,FINS and IR were further decreased than 14-week treatment(P<0.05).Compared to Insulin aspart 30 group,BMI,P2 h BG,Hb A1 c,TC of Liraglutide group after14-week treatment were significantly decreased(P<0.05).Weight,BMI,waist circumference,WHR,FBG,P2 h BG,TC and LDL-C of A group were also significantly decreased(P<0.05)and P2 h BG were increased(P<0.05).The descend range of weight,BMI,waist circumference,WHR and TC of Liraglutide group were higher than Insulin aspart 30 group,however,The descend range of P2 h BG of Insulin aspart 30 group was higher than Liraglutide group(P<0.05).There were no serious adverse events in two groups.The main adverse event in Liraglutide group was gastrointestinal reaction,and in Insulin aspart 30 group were hypoglycemia.3.The change of lipid metabolism indices before and after treatment between two groups: compared to pre-treatment,fat content,fat percentage and FGF21 of Liraglutide group after 14-week treatment were significantly decreased(P<0.05),the level of Irisin was significantly increased(P<0.05).Fat content,fat percentage,FGF21 of Liraglutide group after 26-week treatment were significantly decreased(P<0.05),and Irisin was significantly increased(P<0.05).Compared to Insulin aspart 30 group,fat content,fat percentage and FGF21 of Liraglutide group after 14-week treatment were significantly decreased(P<0.05).Fat content,fat percentage were significantly decreased(P<0.05),while Irisin was significantly increased after 26-week treatment(P<0.05).Compared to Insulin aspart 30 group,the descend ranges of fat content,fat percentage were markedly higher(P<0.05),the ascending range of Irisin were markedly higher(P<0.05).4.The change of bone metabolism indices before and after treatment between two groups: compared to pre-treatment,β-CTX of Liraglutide group after 14-week treatment was significantly decreased(P<0.05),while BMD and N-MID-OT had no obvious difference(P>0.05).β-CTX after 26-week treatment were further declined(P<0.05),however,BMD and N-MID-OT still had no obvious difference(P>0.05).Compared to Insulin aspart 30 group,the levels of BMD,β-CTX,N-MID-OT had no obvious difference between two groups after 14-week and 26-week treatment(P>0.05).The change before and after treatment of β-CTX and N-MID-OT also had no significant difference in two groups(P>0.05).5.The change of inflammation factors before and after treatment between two groups:compared to pre-treatment,TNF-α and IL-1 of Liraglutide group after 14-week treatment were significantly decreased(P<0.05),then TNF-α and IL-1 after 26-week treatment were further declined(P<0.05).Compared to 14-week treatment,TNF-α and IL-1 after 26-week treatment were also further declined(P<0.05).Compared to Insulin aspart 30 group,the levels of TNF-α and IL-1 of Liraglutide group were significantly lower after 14-week and 26-week treatment(P<0.05).The descend range of TNF-α in Liraglutide group was significantly higher than Insulin aspart 30 group(P<0.05).Conclusion: 1.T2 DM patients with obesity or overweight have higher fat content,fat percentage,FGF21,bone resorption markers and lower Irisin,total BMD,biochemical markers of bone formation.2.Liraglutide treatment can reduce weight,BMI,WHR,and improve blood lipid effectively,and can control FBG much better than Insulin aspart 30 treatment,while P2h BG was better controlled by Insulin aspart 30.3.Liraglutide treatment can reduce fat content,fat percentage and the level of FGF21,raise the level of Irisin and improve lipid metabolism in T2 DM patients with obesity or overweight.Although little effects on total BMD and bone formation markers,Liraglutide can reduce bone resorption markers β-CTX,inflammatory factors TNF-αand IL-1.Compared to Insulin aspart 30,Liraglutide can improve lipid metabolism and the levels of inflammatory factors better in T2 DM patients with obesity or overweight. |
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