Sönmez Alper, Dinç Mustafa, Taşlıpınar Abdullah, Aydoğdu Aydogan, Meriç Coskun, Başaran Yalcin, Haymana Cem, Demir Orhan, Yılmaz İlker, Azal Ömer
Gulhane Military Medical Academy, Department of Endocrinology and Metabolism, School of Medicine, Ankara/TURKEY.
Gulhane Military Medical Academy, Department of Nephrology, School of Medicine, Ankara/TURKEY.
Exp Clin Endocrinol Diabetes. 2017 Apr;125(4):256-261. doi: 10.1055/s-0042-120708. Epub 2017 Feb 15.
Intensive insulin treatment is bothersome in obese patients with type 2 diabetes mellitus. High insulin dosages further increase weight gain and the risk of hypoglycemia. Glucagon like peptide-1 receptor agonists decrease the insulin need, cause weight loss and reduce the risk of hypoglycemia. There is limited data about the effect of exenatide on obese diabetics under intensive insulin regimens. This retrospective case series report the clinical outcomes of 23 obese (13 morbidly obese) patients with uncontrolled type 2 diabetes mellitus (Age=59±10.44 years, body mass index 41.1±6.8 kg/m, HbA1c 9.9±1.5%), under high dose (94.1±39.6 unit) intensive insulin. Exenatide twice daily was added for a mean follow-up period of 11.22±7.01 (3-30) months. Intensive insulin regimens were continued in 7 patients while the others were switched to basal insulin during the follow-up. During the follow-up, mean HbA1c levels of the patients significantly improved (p=0.019), along with the significant decrease in body mass index and the total insulin need (p<0.001 for both). Baseline insulin dosages were significantly higher in the intensive regimen group (p=0.013) while other demographical and clinical characteristics were similar. No significant difference was present between the groups regarding the alterations of HbA1c, body mass index and the reduction in total insulin dosages. Add on exenatide appears to be a rational treatment modality in uncontrolled obese patients with type 2 diabetes mellitus despite intensive insulin regimens. Further prospective randomized studies with longer follow-up periods are recommended.
强化胰岛素治疗对于肥胖的2型糖尿病患者来说很麻烦。高剂量胰岛素会进一步增加体重增加和低血糖风险。胰高血糖素样肽-1受体激动剂可减少胰岛素需求、导致体重减轻并降低低血糖风险。关于艾塞那肽对接受强化胰岛素治疗方案的肥胖糖尿病患者的影响的数据有限。本回顾性病例系列报告了23例肥胖（13例病态肥胖）的2型糖尿病患者（年龄=59±10.44岁，体重指数41.1±6.8 kg/m²，糖化血红蛋白9.9±1.5%）在高剂量（94.1±39.6单位）强化胰岛素治疗下的临床结局。每日两次添加艾塞那肽，平均随访期为11.22±7.01（3 - 30）个月。7例患者继续接受强化胰岛素治疗方案，而其他患者在随访期间改用基础胰岛素。在随访期间，患者的平均糖化血红蛋白水平显著改善（p = 0.019），同时体重指数和总胰岛素需求显著下降（两者p均<0.001）。强化治疗方案组的基线胰岛素剂量显著更高（p = 0.013），而其他人口统计学和临床特征相似。两组在糖化血红蛋白、体重指数的变化以及总胰岛素剂量的减少方面没有显著差异。对于尽管接受强化胰岛素治疗方案但仍未得到控制的肥胖2型糖尿病患者，添加艾塞那肽似乎是一种合理的治疗方式。建议进行更长期随访的进一步前瞻性随机研究。
