Comparative Efficacy Of Exenatide In Different Times Of Injection In The Treatment Of Type 2 Diabetes

Background:Currently, the industry for the study of type 2 diabetes becomes deeper and deeper. In 2008 Derronzo professor put forward the famous response type 2 diabetes pathophysiology change theory. He pointed out that besides the islet β-cell function damage, output increased liver glycogen, peripheral tissues to insulin produced resistance to the three known defects, many with glucose metabolism related organizations and organs also participated in the occurrence and development of type 2 diabetes, including the decomposition of fat increased, incretin hormone weakened, islet α-cell secretion of glucagon, increased after renal reabsorption of glucose, central nervous system neurotransmitter function appear obstacles. This for the treatment of type 2 diabetes mellitus presents significant challenges, the industry’s urgent need for a comprehensive consideration of different risk factors of drug, glucagon-like peptide-1(GLP-1) analogues arises at the historic moment. Exenatide as the first approved GLP-1 analogues, both have excellent hypoglycemic ability and balance weight loss, regulating blood fat, improve insulin resistance, lower blood pressure, the advantages, application prospect is very gratifying. Along with the deepening of the clinical research, exenatide in glycemic control research data has become increasingly rich, traditional twice a day of injection can effective control the blood glucose after breakfast and dinner, but the study found the for postprandial blood glucose control effect is weak, and long-acting GLP-1 analogues of ratio, use of exenatide treatment of patients more prone to blood glucose fluctuations. By exenatide plug of the peptide pharmacokinetics characteristics shows that, the half-life of 2.4h, twice injection one day is the reason for lunch after the glucose effect may be weak and has a short half-life, drug concentration maintained a steady ability is weak. In theory, small dose multiple injections is to maintain the body of drug concentration at steady state in the best way, but the reported very little.Objective:This study in overweight type 2 diabetic population as the research object, were given different doses and the number of injections of exenatide, plug the peptide in the treatment of 6 months were observed compared the biochemical index changes, for patients with type 2 diabetes using exenatide provide more suitable treatment.Methods:The study included a total of 23 subjects, both in the Southwest Hospital Endocrinology and Metabolic diseases of type 2 diabetes mellitus(T2DM). To the detailed description of the purpose, process and the specific methods of operation and signed informed consent into the group, according to the random number table method is divided into two needle group(exenatide 10 ug 2 times a day) and three- needle group(exenatide 5ug 3 times a day). After 1 weeks of drug delivery period(exenatide 5ug 1 times a day) starting of observation for 6 months.At the time of the subject to observe collected their gender, age, height(H), body weight(W), body mass index(BMI), whether complicated with hypertension or hyperlipidemia, combined with oral hypoglycemic agents or insulin, the statistical correlation analysis.In this study, a total of 2 times followed up. The follow-up time respectively after 1 week of small doses of the drug import and completed 6 months of treatment period. Every follow-up were collected following observation indexes: height(H), body weight(W), body mass index(BMI), waist circumference(W)(H), hip circumference, waist hip ratio(W/H), fasting blood glucose(FPG), 2 hour postprandial blood glucose(2hPG), fasting, postprandial C peptide 2 hours C peptide, glycosylated hemoglobin(HbA1C), total cholesterol(Tch), triglyceride(TG), low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C), alanine aminotransferase(ALT), aspartate aminotransferase(AST), serum creatinine(Cr), urea nitrogen(UN), three days before the follow-up of fasting blood glucose, blood glucose after meals early in the evening, before going to bed at 2 in the morning the night of blood glucose and blood glucose self-monitoring of blood glucose(SMBG), statistical analysis of the above indexes.Monthly telephone follow-up time, record the patient’s W, BMI, W, h, SMBG and adverse reactions, adverse reactions mainly includes fatigue sweating, general discomfort, nausea, vomiting and other gastrointestinal reactions, dizziness, headache, nervous system discomfort, acute pancreatitis, acute liver dysfunction, acute renal damage.Results:1.During the period of 1 week of small dose drug delivery period, 3 patients due to severe gastrointestinal reaction cannot tolerate out of this study, of which two needle group(n = 2), three needle group(n = 1), the remaining 20 cases with good compliance to at the end of observation No 1 cases lost to follow-up.2.Two acupuncture group and acupuncture group of patients after 6 months of AI plug the peptide after treatment, the W, W, w / h, FPG, PPG, HbA1 c, TCH, TG, LDL-C were compared with those before treatment declined, high-density lipoprotein cholesterol(HDL-C), fasting C peptide and postprandial 2 hour C peptide increased, but after a between group comparison, the difference of the two no statistical significance(P > 0.05), BMI in the two groups of patients after treatment than before treatment significantly decreased, the three needles group BMI decreased compared with two needle group was significantly, and the difference has statistical significance(P < 0.05);3.Two acupuncture group and acupuncture group of patients after 6 months of AI plug the peptide after treatment, compared with before treatment, SMBG was significantly decreased, the blood sugar(12.56 + 1.32mmol/L) three needles group patients after lunch, bedtime blood glucose(8.97 + 1.07mmol/L) than those of the other two needle group lunch after blood glucose(13.25 + 1.23mmol/L), sleep of blood glucose(9.78 + 0.70mmol/L) lower, and the difference has statistical significance(P < 0.05).Conclusion:1.Exenatide 5ug three times a day of injection and 10 ug twice a day of injection compared to more conducive to control the blood glucose after lunch.2.Exenatide 5ug a day three times injection can also get effective improvement and control in patients with type 2 diabetes high blood glucose, disorder of lipid metabolism and body mass.