Systematic Evaluation Of The Effects Of GLP-1 Receptor Agonists On Islet Cell Function In Overweight And Obese Type 2 Diabetic Patients

Objectives:Glucagon-like peptide-1 receptor agonist(GLP-1 RA)is a novel hypoglycemic agent that is effective in the treatment of diabetes,especially in patients with overweight or obesity,but benefit effects and mechanisms remain to be studied.We aimed to determine whether GLP-1RAs exhibit different efficacies on pancreatic cell function between type 2 diabetes(T2DM)patients with overweight or obesity.Methods:Randomized controlled trials were searched in Pubmed,Embase,OVID,Medline,Cochrane Library,CNKI,Wanang data,Weip data and other databases of GLP-1 receptor agonists in patients with overweight or obesity type 2diabetes.The search time was from database construction to December 2018.Two researchers independently screened the literature based on inclusion and exclusion criteria,extracted data,and evaluated the quality of the selected literature,using Revman5.3 statistical software to analyze the data.The heterogeneity test of the literature used?~2 test,I~2 statistics.Results:The systematic review finally included 13 RCTs with a total of 2591patients.All of the articles were published in English.Compared with the control group,GLP-1 receptor agonists significantly reduced fasting blood glucose[MD=–0.28,95%CI(–0.48,–0.08),P=0.007]and glycated hemoglobin(HbA1c)[MD=–0.44,95%CI(–0.74,–0.14),P=0.004],especially for obese patients with type 2diabetes.In terms of improving body weight,GLP-1 receptor agonists were significantly better than the control group[MD=–2.42,95%CI(–4.14,–0.69),P=0.006],especially for obese patients[MD=–2.62,95)%CI(–5.00,–0.24),P=0.03].The results of the analysis showed that GLP-1 receptor agonists were superior to the control group in improving BMI in overweight and obese patients,and the effect was more obvious in obese patients[MD=–2.00,95%CI(–3.86,–0.14),P=0.04].Compared with other anti-diabetic drugs,GLP-1 receptor agonists can increase pancreatic cell function in obese patients[MD=5.80,95%CI(3.16,8.45),P<0.0001],but not significant in patients with overweight.GLP-1 receptor agonists were significantly better than the control group in reducing systolic blood pressure[MD=-3.11,95%CI(-5,50,-0.72),P=0.0002].The effects of triglyceride(TG)in the experimental group and the control group were comparable[MD=-0.13,95%CI(-0.28,0.01),P=0.07],while in the case of low-density lipoprotein(LDL),the experimental group and the control group showed significant differences[MD=-0.23,95%CI(-0.42,-0.04),P=0.02].In terms of adverse reactions,the risk of hypoglycemia was similar[RR=0.41,95%CI(0.32,0.51),P<0.00001],and GLP-1 receptor agonist gastrointestinal reactions were more common[RR=2.95,95%CI(2.29,3.80),P<0.00001],but it is short and slight.Conclusions:GLP-1 receptor agonists are superior to the control group in improving blood glucose,reducing body weight and protecting pancreat cells,especially for obese type 2 diabetes patients,and other risk factors related to diabetes such as blood pressure and blood lipids,GLP-1 receptor agonists also showed significant effects,but their gastrointestinal reactions were more common,to a lesser extent and transient.Therefore,GLP-1 receptor agonists provide a new hypoglycemic agent option for patients with type 2 diabetes,especially for overweight or obese patients.