Pi-Sunyer F Xavier
Obesity Research Center, St. Luke's-Roosevelt Hospital Center, New York, NY 10025, USA.
Postgrad Med. 2008 Jul;120(2):5-17. doi: 10.3810/pgm.2008.07.1785.
Type 2 diabetes mellitus and obesity share a pathogenic relationship, and both have rapidly increased in prevalence over the past decade. This review evaluates the effects of antidiabetes therapies on weight and glycemic control in the type 2 diabetes mellitus population. A PubMed search was conducted to identify randomized controlled trials that reported the weight effects of antidiabetes treatments. The search focused on the newer incretin-based therapies, including dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) agonists. Antiobesity drugs and treatment options potentially available to patients with type 2 diabetes mellitus, including bariatric surgery, were also examined. Most of the established antidiabetes therapies (eg, sulfonylureas, thiazolidinediones) promote weight gain, thereby exacerbating insulin resistance and glucose intolerance. Dipeptidyl peptidase-4 inhibitors exhibit a weight-neutral profile, however, and GLP-1 receptor agonists (eg, exenatide, liraglutide) have achieved significant body weight reductions in spite of improved glycemic control, which is often accompanied by weight gain. Antiobesity drugs, such as orlistat and sibutramine, are effective weight-lowering agents in patients with type 2 diabetes mellitus, but safety and tolerability concerns may limit their use. Bariatric surgery in obese patients is associated with improved glycemic values and decreased mortality. Clinical evidence substantiating the weight-neutral effects of DPP-4 inhibitors and the weight-loss effects of GLP-1 agonists is promising, offering an expansion of therapeutic options for overweight and obese patients with type 2 diabetes mellitus. Evidence on the clinical utility of antiobesity drugs is more equivocal, and more data are needed to evaluate the safety and tolerability of these agents.
2型糖尿病与肥胖存在共同的致病关系，且在过去十年中其患病率均迅速上升。本综述评估了抗糖尿病治疗对2型糖尿病患者体重和血糖控制的影响。通过PubMed检索以识别报告抗糖尿病治疗体重影响的随机对照试验。检索重点为新型肠促胰岛素疗法，包括二肽基肽酶-4（DPP-4）抑制剂和胰高血糖素样肽-1（GLP-1）激动剂。还研究了2型糖尿病患者可能使用的抗肥胖药物和治疗选择，包括减重手术。大多数已确立的抗糖尿病疗法（如磺脲类、噻唑烷二酮类）会促进体重增加，从而加剧胰岛素抵抗和葡萄糖不耐受。然而，DPP-4抑制剂显示出体重中性的特征，尽管血糖控制改善时通常会伴随体重增加，但GLP-1受体激动剂（如艾塞那肽、利拉鲁肽）已实现显著的体重减轻。抗肥胖药物，如奥利司他和西布曲明，对2型糖尿病患者是有效的减重药物，但安全性和耐受性问题可能会限制其使用。肥胖患者进行减重手术与血糖值改善及死亡率降低相关。证实DPP-4抑制剂体重中性作用和GLP-1激动剂减重作用的临床证据很有前景，为超重和肥胖的2型糖尿病患者提供了更多治疗选择。关于抗肥胖药物临床效用的证据更为模糊，需要更多数据来评估这些药物的安全性和耐受性。
