Compare The Effectiveness Between Liraglutide And Insulin Glargine In Nonalcoholic Fatty Liver Disease Patients With Type 2 Diabetes Mellitus Using H-MRS

ObjectiveThe paper aims at studying the effects of symptom relief offered by gluca gon-like peptide-1(GLP-1) liraglutide or basal glargine insulin in fatty liver among the patients with Type 2 Diabetes Mellitus(T2DM)inadequately controlledon metformin alone and the Nonalcoholic Fatty Liver Disease(NAFLD). H-MRS technology is used to analyze the difference of efficacy from liraglutide and glargine insulin.The results of this study could provide the basis for rational use of drugs for T2 DM patients with NAFLD in clinical practices.Method90 T2 DM patients, who had inadequate glycaemic control on metformin, were allocated adopting a randomized open parallel controlled clinical research method.The targeted patients are aged from 18 to79 years with HbA1 c between7.5% and 10.0% and BMI≧25kg/m2.In the study,90 T2 DM patients are kept being offered with the original dosage regimen of metformin and random-ly all ocated to the liraglutide(LIRA) group or the insulin glargine(IGla) group with the proportion of one-to-one. In LIRA group, the starting dose is 0.6mg subcut aneous injection qd. After one week,the dose is changed to 1.2mg inje-ction q d,and such dose is kept unchanged till the end of research.On the other hand, another half patients in IGla group were offered with a starting dose of 0.1~0.2U/kg. The patients are required to conduct self-monitoring of peripheral blood glucose before breakfast.The dose of insulin glargine is adjust according to the continuous 3-day peripheral blood glucose levels of patients before the weekly telephone follow-up.The treatment cycle lasts for 26 weeks. At the baseline an dthe time when the treatment cycle ends respectively, each patient is arranged with physical examinations in terms of liver MRI,body height,weight, waistline,oral glucose tolerance test(OGTT), liver and kidney function, blood amylase, Fasting plasma glucose(FPG), Hb A1 c, Total cholesterol(TC), Triglyceride(TG), High density lipoprotein cholesterol(HDL-C) and Low density lipoprotein cholesterol(LDL-C).Results1.In the study, 87 out of 90 TD2 M Patients completed treatment cycle, among whom 44 cases belong to the LIRA group and 43 cases belong to IGla group.The general information and physical indicators of all the patients at the baseline are comparable in both groups.2.In the aspect of liver-MRI results, Levels of IHCLof patients in both the LIRA and IGla groups apparently decrease(P<0.05). After 26 weeks of treat-m ent, it is found that the drop in IHCL levels is more evident in LIRA group than IGla group(P<0.01).Patients’ levels of Visceral Adipose Tissue(VAT) and Subcutaneous Adipose Tissue(SAT)are both discovered to decline after treatment in LIRA group(P<0.05),however not obviously changed in IGla group(P>0.05).3.2hPG are all found to significantly decrease in both LIRA and IGla group(P<0.05). After treatment, no obvious difference in terms of Hb A1 c has be en foundcomparing LIRA and IGla group However,FBG levels in IGla group a re found to be significantly lower than LIRA group(P<0.01),while 2h PG levels are foundto be lower in LIRA group then IGla group(P<0.05).Regarding the HOMA-IR,the levels of that significantly dropped after treatment in LIRA grou p(P<0.05),however, not obviously changed in IGla group(P>0.05).4.In terms of patients’ body weight control and improvements in lipid met abolism, those indicators all significantly decrease in LIRA group(P<0.05) after26 weeks of treatment,while they are found to be slightly higher in IGla group comparing before treatment(P<0.05).Patients’ TG levels in LIRA group are lowercomparing to those before treatment(P<0.01),but no obvious difference of that is found in IGla group(P>0.05).5.With respects to the safety and tolerability in two groups, the incidence rate of gastrointestinal adverse reaction is observed to be significantly higher in LIRA group than IGla group(P<0.05),but the symptom of such adverse reaction is mild and can be self-relieved within one week. During the treatment, the incidence rate of hypoglycemia event has been found be significantly lower in L IRA group than IGla group(P<0.05). No severe hypoglycemia event is foundin both groups.Conclusions:1.For the treatment to TD2 M patients with NAFLD,when poor control of blood glucose happens with single adoption of melbine, the efficacy of extra combination with liraglutide or Insulin glargine is similar. Both of the drugs could effectively control the blood glucose.2.Comparing to Insulin glargine, liraglutide can more effectively reduce the IHCL for TD2 M patients with NAFLD, showing special advantages over the treatment to fatty liver.3.Comparing to Insulin glargine, liraglutide shows more significant efficacy in weight reduction and blood lipid profile improvements.4.Both liraglutide and lnsulin glragine have good safety and tolerability. Liraglutide is found to be associated with lower incidence rate of hypoglycemia but higher incidence rate of gastrointestinal adverse reactions.5.H-MRS technology has the characteristics of reproducibility, repeatability and veracity. It can be effectively applied on the quantitative diagnosis and me dicine selections of fatty liver.