Comparison Of The Effects Of Saxagliptin Or Glimepiride Combined With Metformin On Body Composition And Heart Function In Patients With Type 2 Diabetes

Objective:This study aims to analyze the glycemic control and the change of body composition of DPP-4 inhibitor and sulfonylureas in patients with type 2 diabetes mellitus who are inadequately controlled with metformin monotherapy.Methods:From January 2015 to March.2016,70 patients with confirmed type 2 diabetes mellitus who are aged between 25 to 75 years old,have BMI between 20 to 30kg/m2,HbA1c between 7.0 to 9.0%and have already used metformin at least 1500mg/d for eight weeks were recruited in Nanjing drum tower hospital.70 patients met the criteria were randomized to either Saxagliptin group or Glimepiride group.Patients in Saxagliptin took metformin 1500mg and Saxagliptin 5mg dairy while patients in Glimepiride group took metformin 1500mg and glimepiride 1-6 mg daily(the dose should be adjusted with fast blood glucose)until the end of 48 weeks.Patients took standard meal test(75-gram instant noodles)?DEXA and two-dimensional echocardiography to test fasting plasma glucose,2h-postprandial plasma glucose,body composition and LAD,IVSTd,LVDd,LVDs,LVPWT,AOD,PA,E,A,e,and calculated E/A,E/e,LVMI.Results:After 48 weeks,the mean change in HbAlc from baseline was 0.77%with saxagliptin and 1.16%with glimepiride.The proportion of patients with an HbA1c<7%was 45%and 55.9%with saxagliptin and glimepiride,respectively.Relative to baseline,Fasting plasma glucose(FPG)reductions?2h-plasma glucose reductions and HOMA-IR change were comparable between groups.Saxagliptin was associated with weight loss(0.07 kg)compared with weight gain(1.26 kg)with glimepiride.Saxagliptin significantly reduced waist circumference relative to glimepiride.(mean change from baseline-1.99 vs.+1.07cm;p<0.05).According to DEXA results,glimepiride significantly increased fat content relative to saxagliptin(mean change from baseline(+1.07cm vs-1.99cm;p<0.005).Saxagliptin significantly reduced fat content relative to glimepiride.(mean change from baseline-0.06 vs.+1.47cm;p<0.05),while there was no significant diffidence between saxagliptin and glimepiride in content of muscle and bone.Further analysis of the change of each part of the body fat content,found that upper limbs and the android area both increased in two groups.Fat content of the lower limbs,trunk and Gynoid was decreased significantly from baseline in saxagliptin while glimepiride were increased significantly.Saxagliptin significantly increased heart rate and LVMI,while glimepiride increased PA(P<0.05).Conclusions In Chinese type 2 diabetes patients whose glucose were inadequately controlled with metformin monotherapy,Saxagliptin can reduce HbA1c as much as glimepiride with less hypoglycemia events and weight loss.Glimepiride could significantly increase fat content in type 2 diabetes,while saxagliptin did not affect the body components.Saxagliptin significantly increased heart rate and LVMI.