Effect Of Liraglutide On Metabolism And Body Composition In Obese Patients With Type 2 Diabetes Mellitus

With the improvement of the economy and changes in people's lifestyles,the global prevalence of type 2 diabetes has increased significantly in recent decades.The latest epidemiological survey results in China show that the prevalence of type 2 diabetes in china has also reached 11.2%,and diabetic patients are often accompanied by overweight and obesity.In 2013,the World Health Organization(WHO)survey results showed that obesity accounted for 45.8%of patients with type 2 diabetes.In the same period,china's data also showed that among adult patients with type 2 diabetes,overweight accounted for 41%,obesity accounted for 24.3%,and Abdominal obesity accounted for 45.4%.Current treatment models for obesity include lifestyle interventions,medications,and metabolic surgery.However,whether it is diet control or metabolic surgery,while weight loss,the patient will also experience a decrease in muscle mass,and severe cases can also lead to sarcopenia.Loss of muscle mass can have many adverse effects on the body,including decreased resting metabolic rate,decreased mobility,fatigue,increased risk of injury,etc,and can have adverse effects on mood and mental state.Therefore,attention should be paid to changes in body composition and muscle function during weight loss.Ectopic fat deposition is an important cause of insulin resistance and chronic inflammation in the body,and abdominal obesity is associated with cardiovascular disease,non-alcoholic fatty liver,metabolic diseases(such as type 2 diabetes,hyperlipidemia,etc.),and muscle loss Symptoms are closely related.There is a need for clinical imaging studies that can quickly and easily assess the distribution of abdominal fat.For obese patients with type 2 diabetes,how to avoid the loss of muscle mass and function while losing weight is a problem that clinicians need to pay attention to.Therefore,this study intends to use the energy spectrum CT method to assess the distribution characteristics of adult body composition and abdominal fat,and to observe the GLP-1(Glucagon-like peptide-1)receptor agonist liraglutide on the metabolic indicators of obese type 2 diabetic patients,Body composition and abdominal fat distribution.The first partUsing energy spectrum CT to evaluate the characteristics of adult abdominal fat distribution and analyze its influencing factorsResearch purposesThe energy spectrum CT method is used to evaluate the characteristics of adult abdominal fat distribution,and to analyze the influence of body mass index,age,gender and different glucose metabolism states on abdominal fat distribution.Research method105 cases of 18-65 year old adults with stable weight(weight fluctuation<5%in the first 3 months of enrollment)were enrolled,and blood routine,blood biochemistry,and glycosylated hemoglobin were tested on an empty stomach.The fixed staff will measure the height and weight of the subjects,calculate the body mass index(BMI),measure the waist circumference and hip circumference,and calculate the waist-to-hip ratio(WHR).All subjects were divided according to body mass index(BMI<24kg/m2 is the normal group,24?BMI<28 kg/m2 is the overweight group,28 kg/m2?BMI is the obesity group),age(youth group<40 years old and Middle-aged group?40 years old group),gender(male group and female group)and glycosylated hemoglobin(HbA1c<6.5%group and HbA1c?6.5%group).Abdominal scanning was performed using energy spectrum CT,and the transverse process of L3 vertebral body was selected for relevant measurement.The measured data included:abdominal cavity area,subcutaneous fat area,anterior abdominal wall,back and bilateral vertebral posterior paramuscular fat thickness,double the relative density of muscle and fat in the myofascial muscle of the posterior vertebral body,liver CT value and spleen CT value.Compare the related parameters of body measurement index and abdominal fat distribution.Research result1.The waist circumference,hip circumference,WHR,abdominal area,subcutaneous fat area and thickness of the obesity group and the overweight group were higher than those of the normal group,and the difference between the three groups was statistically significant(P<0.05).The muscle content and intramuscular fat content(IMAT)content among the three groups were not statistically significant.2.There was no statistical difference in weight and BMI between the youth group and the middle-aged group.The waist circumference,WHR,and BMI of the middle-aged group?the abdominal cavity area and IMAT were higher than those of the youth group,and the muscle content of the middle-aged group was lower than that of the youth group.The difference between the two groups was statistically significant(P<0.05).3.There was no statistically significant difference in BMI,waist circumference and WHR between males and females,but the results of energy spectrum CT showed that the abdominal area and muscle content of the male group were higher than those of the female group,while the subcutaneous fat area and abdominal area of the female group The thickness of subcutaneous fat and the content of IMAT were higher than the male group,and the difference between the two groups was statistically significant(P<0.05).4.The body weight,BMI,waist circumference,hip circumference,waist-to-hip ratio,abdominal cavity area,subcutaneous fat area,and subcutaneous fat thickness of the diabetic group were higher than those of the non-diabetic group,while the erector spinae muscle content and the liver CT value/the spleen CT value was lower than that of the non-diabetic group,and there was a statistical difference between the two groups(P<0.05).There was no significant difference in IMAT between the two groups.ConclusionEnergy spectrum CT can be used to detect body composition and abdominal fat distribution.BMI,age,gender,and abnormal glucose metabolism are all important factors affecting body composition and abdominal fat distribution.The analysis of body composition and ectopic fat distribution can provide a basis for obese diabetic patients to choose appropriate hypoglycemic drugs.The second partEvaluation of the effect of liraglutide on metabolism and body composition in obese patients with type 2 diabetesResearch purposesTo observe the effect of GLP-1 receptor agonist liraglutide on the metabolic indexes,body composition and abdominal fat distribution in obese type 2 diabetic patients.Research methodThis study is a before and after control study.Thirty-nine patients with type 2 diabetes who were admitted to the Endocrinology Clinic of our hospital were sequentially enrolled.The inclusion criteria were 18-65 years old,BMI?28kg/m2,HbA1c?6.5%.Use questionnaires to investigate personal history,diabetes and related complications,and baseline medication.Liraglutide was applied for 12 weeks on the basis of keeping the original hypoglycemic,lipid-lowering and antihypertensive drugs unchanged.The dose of liraglutide starts at 0.6 mg/d and is gradually increased to the maximum tolerated dose,but does not exceed 1.8 mg/d.Compare before and after medication,the subjects' metabolic indicators(blood sugar,blood lipids,uric acid,insulin resistance index HOMA-IR),body measurement indicators(height,weight,body mass index BMI,waist circumference,hip circumference,waist-to-hip ratio WHR and grip strength),resistance antibody component test results and the parameters related to the abdominal fat distribution obtained from the energy spectrum CT abdominal scan.And record the drug-related adverse reactions(gastrointestinal reactions,hypoglycemia,etc.)during the medication process,and evaluate the drug's liver and kidney safety.Research result1.Liraglutide can reduce the subjects' glucose and lipid metabolism-related indicators including HbAlc,total blood cholesterol(TC)and low-density lipoprotein cholesterol(LDL-C).The difference before and after treatment was statistically significant(P<0.05).2.Liraglutide can reduce the weight,BMI and waist circumference of subjects,and the difference before and after treatment reached statistical significance(P<0.05).However,there was no statistical difference in grip strength before and after the medication.3.Liraglutide can reduce the body fat content?body fat ratio?visceral fat area?abdominal fat area,subcutaneous fat area,increased liver CT value/spleen CT value,the difference before and after treatment was statistically significant(P<0.05);while the total muscle content and the muscle content of the L3 plane erector spinae were not significantly different than before treatment.4.The glomerular creatinine clearance rate(eGFR)decreased slightly after treatment,although there was statistical difference,the mean values of the two groups were in the normal range,and there was no clinical significance.There was no significant difference in other indexes of liver and kidney function before and after treatment.Analysis conclusionLiraglutide can significantly improve glucose and lipid metabolism in obese patients with type 2 diabetes.Liraglutide can reduce body weight,fat content,visceral fat area,subcutaneous fat area and abdominal fat area,without affecting muscle content and muscle strength.Patients have a good tolerance for liraglutide and Liraglutide has high liver and kidney safety.