| Objective:Glucagon-like peptide 1 is a 31-amino acid gastrointestinal hormone released by L cells of gastrointestinal tract after eating.Its physiological function is to regulate islet?cells and secrete insulin by relying on glucose concentration to maintain the glucose stable state in the body,and also to inhibit the patient's appetite for food.Delay food emptying rate in stomach,dilate cardio-cerebrovascular,protect cardiovascular,nutritional nerve and so on.Studies show that overweight people are about 1.7 times more likely to develop diabetes than those of normal weight,while obese people are 2.3 times more likely to develop diabetes.A study in Pakistan has shown that one of the effective indicators for predicting insulin resistance in adults[1].IR is an important link between obesity and disorders of glucose and lipid metabolism,and the mechanism of obesity leading to IR involves abnormal fat deposition.Abnormal secretion of adipose hormones,increased secretion of inflammatory factors and abnormal functional structure of mitochondria[2-4].In addition,studies have shown that obesity and overweight increase the risk of glucose and lipid metabolism disorders in patients with type 2 diabetes mellitus?T2DM?,as well as the incidence of acute chronic diseases represented by cardiovascular and cerebrovascular diseases,in addition to reducing the efficacy of treatment in patients with diabetes[5].After moderate weight reduction,IR?blood glucose and blood lipids were improved in T2DM patients.Therefore,effective control of blood glucose while reducing the weight of obese T2DM patients,can reduce the incidence of insulin resistance in patients,for the benefit of patients.Current studies have found that GLP-1 can improve IR and lipid metabolism through various mechanisms.The two most commonly used GLP-1receptor agonists in clinical practice include exenatide and liraglutide peptide.Although both of them can reduce glucose by binding to GLP-1 receptor,there are significant differences in their chemical structure.There are also differences in patient tolerance to drugs.Although RCT studies suggest similar hypoglycemic effects,real-world studies may have different results due to differences in patient tolerance.In this study,we studied the effects of two drugs on blood glucose,body weight,blood lipids,serum uric acid?UAA?,and the effects of drug tolerance on the clinical efficacy of T2DM patients with overweight or obesity in our department,and compared the effects of the two drugs on the metabolic indexes such as blood glucose,body weight,blood lipids and serum uric acid?UAA?at the maximum tolerated dose of the patients.To provide clinical data for T2DM drug therapy strategy for overweight or obesity.Methods:96 patients with overweight or obese T2DM who were hospitalized in our hospital from September 2015 to December 2017 were selected to count the basic data such as sex,age,history of diabetes,height,time to use GLP-1R agonist and so on.There were 49 cases?31 males,18 females?in the exenatide group.There were 47 cases?33 males and 14 females?in the liraglutide group.The exenatide group was treated with oral hypoglycemic drugs plus exenatide,while the Liraglutide group was treated with oral hypoglycemic drugs for liraglutide peptide for more than 3 months.2hPGs,body mass index?BMI?,HbA1cn,triglyceride?TG?,total cholesterol?TC?,low density lipoprotein cholesterol?LDL-C?,and body weight were observed.Results:the patient's fasting blood glucose was significantly lower than before?P<0.001?[?11.04±4.05?mmol/L vs?7.66±2.45?mmol/L],postprandial 2 hours blood glucose decreased significantly?P<0.001??13.41±4.38?mmol/L vs?9.53±2.80?mmol/L]and glycosylated hemoglobin improved significantly?P<0.001?[?9.05±1.65?%vs?7.27±1.07?%].Heavy,BMI also had significant changes?P<0.001?[?86.71±12.78?Kg vs?81.82±12.93?Kg],?P<0.001?[?29.31±2.79?Kg/m2 vs?27.65±2.80?)Kg/m2].After more than 3 months of treatment,the patients in the liraglutide peptide group also significantly decreased their fasting blood glucose?P<0.001?[11.13±2.97)mmol/L vs?7.78±1.73?mmol/L],also significantly improved postprandial 2 hours blood glucose?P<0.001?[?13.88±3.06?mmol/L vs?9.94±2.16?mmol/L],glycosylated hemoglobin improved significantly?P<0.001?[?9.41±1.36?%vs?7.59±0.94?%],weight,BMI change significantly?P<0.001?[?85.31±15.13?Kg vs?79.50±13.99?Kg],?P<0.001?[?28.98±3.55?Kg/m2 vs?27.04±3.43?Kg/m2].At the same time,the serum lipid profile and uric acid of the two groups were also improved and statistically different before and after treatment.The FPG changes in the two groups were not different?P>0.05?,and there was significant difference in degree of weight loss between the two groups[4.44±2.76)Kg vs?5.85±3.76?Kg]?P<0.05?.Conclusions:Both exenatide and liraglutide can reduce blood sugar,weight,and improve blood lipid metabolism in overweight or obese patients.There is no difference in the reduction of FPG,2hPG,and blood lipid,while liraglutide is more obvious in degree of weight loss.At the same time,the rate of patients withstanding high dose of liraglutide was better. |
PDF Full Text Request