Department of Internal Medicine and Therapeutics, University of Pavia, Italy.
Diabetes Technol Ther. 2010 Mar;12(3):233-40. doi: 10.1089/dia.2009.0141.
Incretin-based therapies have provided additional options for the treatment of type 2 diabetes mellitus. The aim of our study was to evaluate the effects of exenatide compared to glibenclamide on body weight, glycemic control, beta-cell function, insulin resistance, and inflammatory state in patients with diabetes.
One hundred twenty-eight patients with uncontrolled type 2 diabetes mellitus receiving therapy with metformin were randomized to take exenatide 5 microg twice a day or glibenclamide 2.5 mg three times a day and titrated to exenatide 10 microg twice a day or glibenclamide 5 mg three times a day. We evaluated body weight, body mass index (BMI), glycated hemoglobin (HbA(1c)), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), fasting plasma insulin (FPI), homeostasis model assessment insulin resistance (HOMA-IR) index, homeostasis model assessment beta-cell function (HOMA-beta) index, plasma proinsulin (PPr), PPr/FPI ratio, resistin, retinol binding protein-4 (RBP-4), and high-sensitivity C-reactive protein (Hs-CRP) at baseline and after 3, 6, 9, and 12 months.
Body weight and BMI decreased with exenatide and increased with glibenclamide. A similar improvement of HbA(1c), FPG, and PPG was obtained in both groups, whereas FPI decreased with exenatide and increased with glibenclamide. The HOMA-IR index decreased and the HOMA-beta index increased with exenatide but not with glibenclamide. A decrease of PPr was reported in both groups, but only glibenclamide decreased the PPr/FPI ratio. Resistin and RBP-4 decreased with exenatide and increased with glibenclamide. A decrease of Hs-CRP was obtained with exenatide, whereas no variations were observed with glibenclamide.
Both exenatide and glibenclamide gave a similar improvement of glycemic control, but only exenatide gave improvements of insulin resistance and beta-cell function, giving also a decrease of body weight and of inflammatory state.
基于肠降血糖素的治疗为 2 型糖尿病的治疗提供了额外的选择。我们研究的目的是评估艾塞那肽对比格列本脲在接受二甲双胍治疗的糖尿病患者的体重、血糖控制、β细胞功能、胰岛素抵抗和炎症状态方面的影响。
128 名血糖控制不佳的 2 型糖尿病患者接受二甲双胍治疗，随机分为两组，每天两次接受艾塞那肽 5μg 或每天三次接受格列本脲 2.5mg 治疗，并滴定至每天两次接受艾塞那肽 10μg 或每天三次接受格列本脲 5mg 治疗。我们评估了体重、体重指数（BMI）、糖化血红蛋白（HbA1c）、空腹血糖（FPG）、餐后血糖（PPG）、空腹血浆胰岛素（FPI）、稳态模型评估胰岛素抵抗指数（HOMA-IR）、稳态模型评估β细胞功能指数（HOMA-β）、血浆胰岛素原（PPr）、PPr/FPI 比值、抵抗素、视黄醇结合蛋白-4（RBP-4）和高敏 C 反应蛋白（Hs-CRP）在基线和 3、6、9 和 12 个月时的水平。
艾塞那肽治疗使体重和 BMI 降低，而格列本脲治疗使体重和 BMI 增加。两组患者的 HbA1c、FPG 和 PPG 均得到相似的改善，而 FPI 则随艾塞那肽治疗而降低，随格列本脲治疗而升高。HOMA-IR 指数随艾塞那肽治疗而降低，HOMA-β 指数随艾塞那肽治疗而升高，但格列本脲治疗无此变化。两组患者的 PPr 均下降，但只有格列本脲降低了 PPr/FPI 比值。抵抗素和 RBP-4 随艾塞那肽治疗而降低，随格列本脲治疗而升高。艾塞那肽治疗降低了 Hs-CRP，而格列本脲治疗则无此变化。
艾塞那肽和格列本脲均使血糖控制得到相似的改善，但只有艾塞那肽改善了胰岛素抵抗和β细胞功能，同时还降低了体重和炎症状态。
