Tong Yan, Huang Jian Qing, Chen Yang, Tu Mei, Wang Wei
Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, China.
Front Pharmacol. 2023 Apr 6;14:1176206. doi: 10.3389/fphar.2023.1176206. eCollection 2023.
Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) and dipeptidyl peptidase-4 inhibitors (DPP-4i) profoundly affect the gastrointestinal motor system, which may increase the incidence of inadequate bowel cleaning and gastrointestinal symptoms. Hence, this observational study mainly aimed to assess the influence of GLP-1 RAs liraglutide and DPP-4i sitagliptin on bowel preparation in type 2 diabetes (T2DM). This observational study consecutively enrolled T2DM scheduled for a colonoscopy. Participants were prospectively separated into the liraglutide group ( = 120), sitagliptin group ( = 120), and control group ( = 120) based on the current hypoglycemic regimen. 3L split-dose polyethylene glycol regimens were used for bowel preparation. Experienced gastrointestinal endoscopists conducted colonoscopies. Lawrance Bowel-Preparation Tolerability Questionnaire and Boston Bowel Preparation Scale (BBPS) were conducted to assess bowel cleaning quality, tolerability, and safety. The incidence of inadequate bowel cleaning was 17.5% in the liraglutide group, 20.5% in the sitagliptin group, and 21.7% in the control group. The difference among the three groups was not statistically significant ( = 0.927). Meanwhile, there were no significant differences in the mean BBPS, cecal intubation time, and polyp-detecting rates among the three groups (all > 0.0.05). Nausea, vomiting, and bloating scores were increased in the liraglutide group compared with the other two groups ( < 0.05), whereas most were mild or very mild. Subgroup analyses showed that the incidence of inadequate bowel cleaning in T2DM with diabetic peripheral neuropathy (DPN) was increased in the liraglutide group compared with the sitagliptin group (61.3% vs. 32.1%, = 0.022) and control group (61.3% vs. 32.8%, = 0.025). GLP-1RA liraglutide or DPP-4i sitagliptin did not significantly increase the incidence of inadequate bowel cleaning and gastrointestinal symptoms during bowel preparation. Liraglutide may increase the incidence of inadequate bowel preparation in patients with DPN. This study reveal that more attention and aggressive bowel preparation regimens should be given to the T2DM with DPN. (https://www.chictr.org.cn/index.aspx), identifier (ChiCTR2200056148).
胰高血糖素样肽-1受体激动剂（GLP-1 RAs）和二肽基肽酶-4抑制剂（DPP-4i）对胃肠运动系统有深远影响，这可能会增加肠道清洁不充分和胃肠道症状的发生率。因此，这项观察性研究主要旨在评估GLP-1 RA利拉鲁肽和DPP-4i西格列汀对2型糖尿病（T2DM）患者肠道准备的影响。这项观察性研究连续纳入了计划进行结肠镜检查的T2DM患者。根据当前的降糖方案，将参与者前瞻性地分为利拉鲁肽组（n = 120）、西格列汀组（n = 120）和对照组（n = 120）。采用3L分剂量聚乙二醇方案进行肠道准备。由经验丰富的胃肠内镜医师进行结肠镜检查。采用劳伦斯肠道准备耐受性问卷和波士顿肠道准备量表（BBPS）评估肠道清洁质量、耐受性和安全性。利拉鲁肽组肠道清洁不充分的发生率为17.5%，西格列汀组为20.5%，对照组为21.7%。三组之间的差异无统计学意义（P = 0.927）。同时，三组之间的平均BBPS、盲肠插管时间和息肉检出率均无显著差异（均P > 0.05）。与其他两组相比，利拉鲁肽组的恶心、呕吐和腹胀评分升高（P < 0.05），但大多数为轻度或非常轻度。亚组分析显示与西格列汀组（61.3%对32.1%，P = 0.022）和对照组（61.3%对32.8%，P = 0.025）相比，合并糖尿病周围神经病变（DPN）的T2DM患者中，利拉鲁肽组肠道清洁不充分的发生率升高。GLP-1 RA利拉鲁肽或DPP-4i西格列汀在肠道准备期间并未显著增加肠道清洁不充分和胃肠道症状的发生率。利拉鲁肽可能会增加DPN患者肠道准备不充分的发生率。这项研究表明，对于合并DPN的T2DM患者应给予更多关注和积极的肠道准备方案。（https://www.chictr.org.cn/index.aspx），标识符（ChiCTR2200056148）
