Woman's Metabolic Clinic and Research Center, Woman's Hospital, Baton Rouge, LA 70817, USA.
Woman's Metabolic Clinic and Research Center, Woman's Hospital, Baton Rouge, LA 70817, USA.
J Diabetes Complications. 2020 Apr;34(4):107548. doi: 10.1016/j.jdiacomp.2020.107548. Epub 2020 Feb 1.
Gestational diabetes (GDM) imparts a high risk of developing diabetes postpartum. Insulin resistance appears to be the major contributor. Liraglutide, a glucagon-like peptide-1 analogue, improves peripheral glucose disposal and reduces body weight. We evaluated whether liraglutide in combination with metformin (MET-LIRA) is more effective than metformin monotherapy (MET-P) in improving insulin action and reducing body weight in overweight prior GDM (pGDM) women.
Women (n = 153; body mass index (BMI) ≥25 kg/m; 18-45 y; GDM within 12 months) with metabolic abnormalities were randomized to MET-LIRA (MET-2000 mg, LIRA 1.8 mg SC QD) or MET-P (MET-2000 mg, Placebo QD). Study visits at baseline, 36-40, 56-60 and 80-84 weeks included body weight (BW), BMI, waist circumference and waist-to-height ratio measures. Oral glucose tolerance tests (OGTTs) were performed to assess glycemia, mean blood glucose (MBG), lipids, and compute insulin sensitivity and secretion measures.
Seventy-two (47%) participants completed the study. MET-LIRA therapy was significantly better in improving MBG and insulin sensitivity indices [SI MET-LIRA from 4.6 (3.2) to 5.9 (2.9) vs. MET-P 5.5 (3.0) to 5.4 (3.2)] and reducing BW and central adiposity [BMI MET-LIRA from 37.2 (8.3) to 33.8 (5.2) vs MET-P 33.8(5.2) to 32.8(6)]. MET-LIRA therapy but not MET-P decreased triglycerides (TRG) and TRG/high density lipoprotein cholesterol (HDL-C) ratios.
MET-LIRA treatment demonstrated superior efficacy in correcting the metabolic status of pGDM women over 84 weeks of therapy. The addition of liraglutide to metformin therapy resulted in a more dramatic decrease in BW and central adiposity than metformin alone.
Supported by an unrestricted investigator initiated grant from Novo Nordisk, Inc. awarded to K.E.H.
The results from preliminary analyses of this study were presented at 76th meeting of the American Diabetes Association, June 10-14, 2016 New Orleans, LA, and 77th meeting of the American Diabetes Association, June 9-12, 2017San Diego, CA.
妊娠糖尿病（GDM）会增加产后发生糖尿病的风险。胰岛素抵抗似乎是主要原因。利拉鲁肽是一种胰高血糖素样肽-1类似物，可改善外周葡萄糖处置并减轻体重。我们评估了利拉鲁肽联合二甲双胍（MET-LIRA）是否比二甲双胍单药治疗（MET-P）更能改善超重的既往 GDM（pGDM）女性的胰岛素作用并减轻体重。
共有 153 名（BMI≥25kg/m2；18-45 岁；GDM 在 12 个月内）存在代谢异常的女性被随机分为 MET-LIRA（MET-2000mg，LIRA 1.8mg SC QD）或 MET-P（MET-2000mg，安慰剂 QD）。基线、36-40、56-60 和 80-84 周时进行体重（BW）、BMI、腰围和腰高比测量。进行口服葡萄糖耐量试验（OGTT）以评估血糖、平均血糖（MBG）、血脂，并计算胰岛素敏感性和分泌指标。
72 名（47%）参与者完成了研究。MET-LIRA 治疗在改善 MBG 和胰岛素敏感指数方面明显更好[MET-LIRA 从 4.6（3.2）改善至 5.9（2.9），而 MET-P 从 5.5（3.0）改善至 5.4（3.2）]，并降低 BW 和中心性肥胖[MET-LIRA 从 BMI 37.2（8.3）改善至 33.8（5.2），而 MET-P 从 33.8（5.2）改善至 32.8（6）]。与 MET-P 相比，MET-LIRA 治疗可降低甘油三酯（TRG）和 TRG/高密度脂蛋白胆固醇（HDL-C）比值。
在 84 周的治疗中，MET-LIRA 治疗在纠正 pGDM 女性的代谢状态方面表现出更好的疗效。与单独使用二甲双胍相比，利拉鲁肽联合二甲双胍治疗可更显著地降低 BW 和中心性肥胖。
由 Novo Nordisk，Inc. 提供的不受限制的研究者发起的赠款资助，授予 K.E.H.
本研究的初步分析结果在美国糖尿病协会第 76 次会议上进行了报告，2016 年 6 月 10-14 日在路易斯安那州新奥尔良举行，第 77 次会议上进行了报告，2017 年 6 月 9-12 日在加利福尼亚州圣地亚哥举行。
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