Bute Medical School, University of St Andrews, St Andrews, Fife, KY16 9TS, UK.
Int J Clin Pract. 2010 May;64(6):791-801. doi: 10.1111/j.1742-1241.2009.02292.x.
Type 2 diabetes patients are usually overweight or obese. Further weight gain induced by antidiabetic treatment should be avoided if possible. Much attention has been focussed recently on the potential for GLP-1 mimetics, in particular, to reduce weight.
Effects on weight are but one of several important criteria in selecting antidiabetic therapy, however. This review explores the effects on weight of older classes of antidiabetic agents (metformin, sulfonylureas, thiazolidinediones) and the newer drugs acting via the GLP-1 system. Other aspects of their therapeutic profiles and current therapeutic use are reviewed briefly to place effects on weight within a broader context.
Comparative trials demonstrated weight neutrality or weight reduction with metformin, and weight increases with a sulfonylurea or thiazolidinedione. There was no clinically significant change in weight with DPP-4 inhibitors and a small and variable decrease in weight (about 3 kg or less) with GLP-1 mimetics. Improved clinical outcomes have been demonstrated for metformin and a sulfonylurea (cardiovascular and microvascular benefits, respectively, in the UK Prospective Diabetes Study), and secondary endpoints improved modestly with pioglitazone in the PROactive trial. No outcome benefits have been demonstrated to date with GLP-1-based therapies, and these agents exert little effect on cardiovascular risk factors. Concerns remain over long-term safety of these agents and this must be weighed against any potential benefit on weight management.
Considering effects on weight within the overall risk-benefit profile of antidiabetic therapies, metformin continues to justify its place at the head of current management algorithms for type 2 diabetes, due to its decades-long clinical evidence base, cardiovascular outcome benefits and low cost.
2 型糖尿病患者通常超重或肥胖。如果可能的话，应避免抗糖尿病治疗引起的进一步体重增加。最近，人们非常关注 GLP-1 拟似物（特别是）减轻体重的潜力。
在选择抗糖尿病治疗时，体重的影响只是几个重要标准之一。本综述探讨了较老类别的抗糖尿病药物（二甲双胍、磺酰脲类、噻唑烷二酮类）和通过 GLP-1 系统作用的新型药物对体重的影响。简要回顾了它们治疗谱的其他方面及其当前的治疗用途，以便将体重的影响置于更广泛的背景下。
比较试验表明二甲双胍具有体重中性或减轻体重的作用，而磺酰脲类或噻唑烷二酮类则会增加体重。DPP-4 抑制剂对体重没有明显的临床影响，GLP-1 拟似物对体重的影响较小且可变（约 3 公斤或更少）。UKPDS 分别在心血管和微血管方面证实了二甲双胍和磺酰脲类药物的改善临床结局，而 PROactive 试验中吡格列酮的次要终点也有适度改善。迄今为止，尚未证明 GLP-1 为基础的治疗方法具有获益，并且这些药物对心血管危险因素的影响很小。这些药物的长期安全性仍然存在担忧，这必须与体重管理方面的任何潜在益处相权衡。
考虑到抗糖尿病治疗的整体风险效益谱对体重的影响，由于其数十年的临床证据基础、心血管结局获益和低成本，二甲双胍继续证明其在 2 型糖尿病当前管理算法中的地位是合理的。
