Preliminary Study Of Exenatide On Pancreal Type2Diabetic Patients

Background：Diabetes (DM) is a common clinical multiple endocrine and metabolicdiseases, a metabolic disease group characterized by elevated plasma glucoselevels,of which the highest incidence is type2diabetes (T2DM)(95%). Itsetiology is a series of pathophysiological states which process is from insulinresistance with relative insulin deficiency to a lack of insulin secretion withvarying degrees of insulin resistance. Compared with intravenous glucose, it isfound when studying the effect of glucose on promoting insulin releasethat the same amount of oral glucose stimulate more release insulin thanintravenous injection of glucose,so that incretin-releasing hormone may exist inthe digestive tract. Stimulation of incretin-releasing hormone may cause moreinsulin release than a simple blood glucose. Glucagon-like peptide-1(GLP-1),which is a major release of incretin hormones, have a wide range ofphysiological functions on pancreas, stomach, brain, heart, kidney, fat, muscleand other tissues and organs. It promotes insulin secretion and biosynthesis,improves insulin sensitivity, inhibits glucagon secretion, increases the numberof pancreatic β cells, inhibits gastric emptying and gastric acid secretion, aswell as appetite suppressants.Objective:Exenatide is GLP-1receptor agonist. The aim of his study was to evaluatethe roles on pancreatic function. By observing the roles said above, we can takereasonable treatment options, optimize glucose management, guide andimprove blood sugar control of type2diabetic patients, thus make Exenatide amore effective clinical treatment. Method:48cases who were clearly diagnosed as type2diabetes in our hospital(onset patients and those who with poor efficacy of oral hypoglycemic drugs,duration from6months to5years, BMI24-30kg/m2, age20-60years) wererandomly divided into two groups (A, B), each group has24cases. Proceed asfollows:(1) Two groups both take dietary interventions and exercise therapys,whose blood sugar levels were adjusted by insulin pump before treatment(3-4days). Their fasting plasma glucose were adjusted to8-10mmol/l, postprandialblood glucose to10-14mmol/l;(2) Fasting Venous blood was extracted in orderto measure liver function, renal function, blood sugar, blood lipids,glycosylated hemoglobin, morning urine was taken in order to measure urinarytrace albumin,75g oral glucose tolerance tests were taken, blood glucose, bloodinsulin, height, waist circumference, body weight, blood pressure,electrocardiogram were measured;(3) Group A: subcutaneous injection ofexenatide; Group B: oral metformin;(4)12weeks after treatment, fastingvenous blood was extracted again in order to measure liver function, renalfunction, blood sugar, blood lipids, glycosylated hemoglobin, morning urinewas taken again in order to measure urinary trace albumin,75g oral glucosetolerance tests were taken again, blood glucose, blood insulin, height, waistcircumference, body weight, blood pressure, electrocardiogram were measuredagain. The observations were represented as x±s, T test was taken tocompare datas between groups. All dates were analyzed by statistical softwareSPSS13.0. P <0.05represents differences statistically significant.Results:Differences of gender, age, disease duration, BMI, and blood glucoselevels between the two groups were not statistically significant. While12weeks after treatment of exenatide or metformin，the experimental observationsindicate that: compared with pre-treatment, fasting blood glucose,120min postprandial blood glucose, glycosylated hemoglobin, body mass index of thetwo groups of patients after treatment decreased significantly(P<0.01). Andexenatide group decreased more than metformin group, differences werestatistically significant(P<0.05). After exenatide treatment, the OGTT test showthat:30min insulin secretion was increased,60min insulin and120min ofinsulin secretion were decreased, differences were statistically significant(P<0.05). Difference of metformin group between pre-treatment and aftertreatment was not statistically significant(P>0.05); Differences between the twogroups were statistically significant(P<0.01). After treatment of exenatide，HOMA-IR decreased significantly, HOMA-HBCI,△I30,△I30/△G30increased significantly, differences were statistically significant(P<0.05). Aftertreatment of metformin，differences were not statistically significant(P>0.05).Differences between the two groups were statistically significant(P<0.01).Changes of ALT, AST, BUN, and Cr, UA, the TC and LDL-C of the twogroups between pre-treatment and after treatment were not statisticallysignificant(P>0.05). TG decreased and HDL-C increased significantly aftertreatment of exenatide(P<0.05). TG decreased significantly after treatment ofmetformin(P<0.05), the change of LDL-C was not statistically significant(P>0.05). Differences between the two groups were statistically significant(P<0.05). Urinary trace albumin decreased significantly after treatment ofexenatide(P<0.05), the change of urinary trace albumin after treatment ofmetformin was not statistically significant(P>0.05). Differences between thetwo groups was statistically significant(P<0.01). Systolic blood pressure,diastolic blood pressure decreased significantly after treatment of exenatide(P<0.05), while their changes were not statistically significant after treatment ofmetformin(P>0.05). Differences between the two groups were statisticallysignificant(P<0.01). There were no significantly low blood sugar reaction inboth groups; There were gastrointestinal adverse reactions such as nausea, vomiting, diarrhea, indigestion and other symptoms in both groups at the earlystage of treatment.Conclusions:As a novel therapy for type2diabetes, exenatide has a differentmechanism of action compared with other antidiabetic drugs, its notablefeatures is its multiple roles such as decreasing blood sugar, improving isletfunction, reducing weight and blood pressure, regulating lipid metabolismdisorders, providing a new way to treat type2diabetes in order to improveglucose and lipid levels, reduce the risk of low blood sugar, high blood pressureand weight gain. Therefore, exenatide is of great significance for the treatmentof type2diabetes.