Effect Of Exenatide On Visceral Fat And Early Renal Injury In Overweight/Obese Patients With Type 2 Diabetes

According to the epidemiological data,the prevalence of diabetes in Chinese adults has reached 10.9%,while the prevalence of diabetes in overweight and obese people is 12.8% and 18.5% respectively.Diabetic Nephropathy(DN)is a kind of the microvascular complications of diabetes,which is a persistent proteinuria(>300 mg/24h)and progressive glomerular filtration rate(GFR)by clinical syndrome characterized.In early stage of DN,urinary microalbuminuria excretion is about 30-300mg/24 h,which was called "Microscale albuminuria(MAU)".The increase of MAU is not only the earliest biochemical manifestation of diabetic nephropathy,but also an important factor affecting the development of DN and the risk of cardiovascular disease.Evidence shows that the glomerular filtration rate of patients with DN decreases at a rate of 2.0-10mL/min per year.End-stage renal disease(ESRD)is the main cause of death in diabetic patients,so early diabetic renal injury should be highly valued.Also a number of studies found that strict control of blood glucose can reduce the occurrence and increase of MAU in diabetic patients,which owns a great significance to the occurrence of early DN or to delay its progression.In addition,some known risk factors such as body mass index(BMI)and age,diabetes course,blood pressure and blood sugar,abdominal obesity was independently correlated with DN.Considered the effects of visceral fat and diabetes and DN described above,for overweight and obese type 2 diabetes patients,controlling blood sugar and improving abdominal obesity has a great significance for delaying the development of DN.Exenatide is a kind of natural glucagon-like peptide-1(GLP-1)analogue,which has been proved to delay gastric emptying,inhibit appetite,reduce body mass and delay insulin cell function decline in type 2 diabetes patients.Animal studies have shown that the exenatide reduces albuminuria excretion and protecting the kidney via glomerular oxidative stress and inflammation.Most of the clinical observation shows the benefits of exenatide in overweight/obese type 2 diabetic patients,mainly focusing on its hypoglycemic,weight reduction,lipid metabolism and other therapeutic effects.There are few studies on the effect of exenatide on DN,especially the early renal injury of diabetes.The objection of this study was to determine the additional renal protective effect of exenatide in overweight and obese patients with type 2 diabetes,which assoiated with reducing blood sugar and weight to figure out whether it is benefit for early DN.The experimental design of this study will focus on the further elaboration and analysis of the early injury indicators,obesity and blood glucose levels of the subjects,to illustrate the effect of the exenatide on early renal injury in overweight/obese with type 2 diabetes patients.The main results and conclusions of this study are as follows:1.A total of 76 obese or overweight T2 DM patients were included in the 2 groups randomly after screening.All the patients completed the trial without loss of visit and they performed a good compliance.After treatment,19 patients(48.72%)in the experimental group presented mild or above gastrointestinal adverse reactions,including 1 patient with moderate adverse reactions.Adverse reactions were performed with 5?g at the first 4 weeks,twice daily subcutaneous injection and at the fifth week,instead of 10?g,twice daily subcutaneous injection appeared,but all of them were transient adverse reactions,which were relieved automatically with the extension of treatment cycle,and no other serious adverse reactions were complicated.2.MAU,VFA,BMI,WHR,FPG and HbA1 c were significantly decreased in the experimental group at 12 weeks and 24 weeks after treatment compared with that at 0 weeks before treatment,while only BMI,FPG and HbA1 c were decreased in the control group(P<0.05).By between groups comparison,MAU,VFA,BMI,FPG and HbA1 c of the experimental group were significantly lower than the control group at 12 and 24 weeks after treatment,and WHR was significantly lower than the control group at 24 weeks after treatment(P<0.05),indicating that exenatide could significantly improve the MAU,blood glucose level and obesity of the patients.3.For experimental group subjects,BMI was significantly positive correlated with VFA,MAU,FPG and HbA1 c was(P<0.05),WHR showed a significantly positive correlation with VFA,MAU,FPG and HbA1c(P<0.05),MAU with MAU,FPG and VFA HbA1 c was significantly positive correlation(P<0.05),MAU was significantly positive correlated with FPG(P<0.05),while the control group did not showed significant correlation between different clinical viarables.It showed that the changes of MAU in the experimental group were closely related to the reduction of VFA,BMI,WHR and blood glucose.In conclusion,exenatide can significantly reduce the excretion of visceral fat area,waist-to-hip ratio,BMI,fasting blood glucose,hba1 c and urinary microalbumin in overweight/obese type 2 diabetes patients.The decrease of MAU excretion is closely related to the decrease of visceral fat area,waist-hip ratio,BMI,fasting blood glucose and Hba1 c.The exenatide prevents early kidney damage in overweight/obese type 2 diabetes.