Ahmadi S S, Filipsson K, Dimenäs H, Isaksson S S, Imberg H, Sjöberg S, Ahrén B, Dahlqvist S, Gustafsson T, Tuomilehto J, Hirsch I B, Lind M
Department of Molecular and Clinical Medicine University of Gothenburg Gothenburg Sweden.
Department of Clinical Sciences Lund Lund University Lund Sweden.
Obes Sci Pract. 2019 Mar 18;5(2):130-140. doi: 10.1002/osp4.324. eCollection 2019 Apr.
Use of the glucagon-like peptide 1 receptor agonist liraglutide has been shown to reduce weight. Different types of anthropometric measurements can be used to measure adiposity. This study evaluated the effect of liraglutide on sagittal abdominal diameter, waist circumference, waist-to-hip ratio and adiponectin levels in people with type 2 diabetes (T2D) treated with multiple daily insulin injections (MDI).
In the multicentre, double-blind, placebo-controlled MDI-liraglutide trial, 124 individuals with T2D treated with MDI were randomized to either liraglutide or placebo. Basal values of weight, waist circumference, waist-to-hip ratio, sagittal abdominal diameter and adiponectin were compared with measurements at 12 and 24 weeks after randomization.
Baseline-adjusted mean weight loss was 3.8 ± 2.9 kg greater in liraglutide than placebo-treated individuals ( < 0.0001). Waist circumference was reduced by 2.9 ± 4.3 cm and 0.2 ± 3.6 cm in the liraglutide and placebo groups, respectively, after 24 weeks (baseline-adjusted mean difference: 2.6 ± 4.0 cm, = 0.0005). Corresponding reductions in sagittal abdominal diameter were 1.1 ± 1.7 cm and 0.0 ± 1.8 cm (baseline-adjusted mean difference: 1.1 ± 1.7 cm, = 0.0008). Hip circumference was reduced in patients randomized to liraglutide (baseline-adjusted mean difference between treatment groups: 2.8 ± 3.8 cm, = 0.0001), but there was no significant difference between the groups in either waist-to-hip ratio (baseline-adjusted mean difference: 0.0 ± 0.04 cm, = 0.51) or adiponectin levels (baseline-adjusted mean difference: 0.8 ± 3.3 mg L, = 0.17). Lower HbA1c and mean glucose levels measured by masked continuous glucose monitoring at baseline were associated with greater effects of liraglutide on reductions in waist circumference and sagittal abdominal diameter.
In patients with T2D, adding liraglutide to MDI may reduce abdominal and hip obesity to a similar extent, suggesting an effect on both visceral and subcutaneous fat. Liraglutide had greater effects on reducing abdominal obesity in patients with less pronounced long-term hyperglycaemia but did not affect adiponectin levels.
已证明使用胰高血糖素样肽1受体激动剂利拉鲁肽可减轻体重。可使用不同类型的人体测量方法来测量肥胖程度。本研究评估了利拉鲁肽对接受每日多次胰岛素注射（MDI）治疗的2型糖尿病（T2D）患者的腹矢状径、腰围、腰臀比和脂联素水平的影响。
在多中心、双盲、安慰剂对照的MDI-利拉鲁肽试验中，124例接受MDI治疗的T2D患者被随机分为利拉鲁肽组或安慰剂组。将体重、腰围、腰臀比、腹矢状径和脂联素的基线值与随机分组后12周和24周时的测量值进行比较。
与安慰剂治疗的个体相比，利拉鲁肽组经基线调整后的平均体重减轻多3.8±2.9kg（P<0.0001）。24周后，利拉鲁肽组和安慰剂组的腰围分别减少了2.9±4.3cm和0.2±3.6cm（经基线调整后的平均差值：2.6±4.0cm，P=0.0005）。腹矢状径的相应减少量分别为1.1±1.7cm和0.0±1.8cm（经基线调整后的平均差值：1.1±1.7cm，P=0.0008）。随机接受利拉鲁肽治疗的患者髋围减小（治疗组间经基线调整后的平均差值：2.8±3.8cm，P=0.0001），但两组在腰臀比（经基线调整后的平均差值：0.0±0.04cm，P=0.51）或脂联素水平（经基线调整后的平均差值：0.8±3.3mg/L，P=0.17）方面均无显著差异。基线时通过隐蔽连续血糖监测测得的较低糖化血红蛋白和平均血糖水平与利拉鲁肽对腰围和腹矢状径减小的更大作用相关。
在T2D患者中，在MDI治疗基础上加用利拉鲁肽可能在相似程度上减轻腹部和髋部肥胖，提示对内脏脂肪和皮下脂肪均有作用。利拉鲁肽对长期高血糖不太明显的患者减轻腹部肥胖的作用更大，但不影响脂联素水平。
