Joslin Diabetes Center, Boston, Massachusetts, USA.
Diabetes Care. 2010 Aug;33(8):1759-65. doi: 10.2337/dc09-2062. Epub 2010 May 11.
Weight loss in patients with type 2 diabetes can improve glycemic control, lower blood pressure, and improve dyslipidemia. Glucagon-like peptide (GLP-1) receptor agonists are associated with weight loss and have potentially beneficial effects on cardiovascular risk biomarkers; however, there is limited information to indicate whether these effects remain outside of clinical trials.
Medical records from the General Electric Centricity research database were analyzed retrospectively to evaluate the relationship between weight loss and glycemic control and changes in blood pressure and lipids in patients with type 2 diabetes initiating therapy with exenatide, sitagliptin, or insulin. Baseline and follow-up (90-365 days after the index date) for weight, A1C, fasting blood glucose (FBG), blood pressure, triglycerides, and LDL, HDL, and total cholesterol were assessed.
A total of 6,280, 5,861, and 32,398 patients receiving exenatide, sitagliptin, or insulin, respectively, were included in the analysis. Exenatide-treated patients lost a mean +/- SD of 3.0 +/- 7.33 kg, sitagliptin-treated patients lost 1.1 +/- 5.39 kg, and insulin-treated patients gained 0.6 +/- 9.49 kg. There was a significant association between weight loss and a reduction in A1C and FBG with exenatide only and a reduction in blood pressure for all therapies. Weight loss was associated with some improvements in lipids, primarily in the GLP-1 receptor agonist group, with little association in the insulin group.
Weight reduction with GLP-1 receptor agonists was associated with a shift toward a more favorable cardiovascular risk profile. Outcome trials are needed to determine whether improvement in biomarkers translates into a reduction in cardiovascular events in patients with type 2 diabetes.
2 型糖尿病患者减轻体重可以改善血糖控制、降低血压并改善血脂异常。胰高血糖素样肽（GLP-1）受体激动剂与体重减轻有关，并可能对心血管风险生物标志物有有益影响；然而，仅有有限的信息表明这些影响是否在临床试验之外仍然存在。
回顾性分析通用电气 Centricity 研究数据库中的病历，以评估在开始接受艾塞那肽、西他列汀或胰岛素治疗的 2 型糖尿病患者中，体重减轻与血糖控制以及血压和血脂变化之间的关系。评估体重、A1C、空腹血糖（FBG）、血压、甘油三酯以及 LDL、HDL 和总胆固醇的基线和随访（索引日期后 90-365 天）。
分别有 6280、5861 和 32398 例接受艾塞那肽、西他列汀或胰岛素治疗的患者纳入分析。艾塞那肽治疗的患者平均减轻了 3.0 +/- 7.33kg，西他列汀治疗的患者减轻了 1.1 +/- 5.39kg，胰岛素治疗的患者增加了 0.6 +/- 9.49kg。仅用艾塞那肽治疗时，体重减轻与 A1C 和 FBG 的降低显著相关，所有治疗方法均与血压降低相关。体重减轻与某些血脂的改善相关，主要在 GLP-1 受体激动剂组中，而在胰岛素组中相关性较小。
GLP-1 受体激动剂的体重减轻与向更有利的心血管风险特征转变相关。需要进行结局试验来确定生物标志物的改善是否会导致 2 型糖尿病患者心血管事件的减少。
