两种 2 型糖尿病患者极低卡路里饮食、司美格鲁肽或两者联合的代谢效果。

Metabolic effects of very-low calorie diet, Semaglutide, or combination of the two, in individuals with type 2 diabetes mellitus.

机构信息

MRC/ARUK Centre for Musculoskeletal Ageing Research and National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre (BRC), School of Medicine, University of Nottingham, Derby, DE22 3DT, UK; Department of Endocrinology and Diabetes, University Hospitals Derby and Burton NHS Foundation Trust, Derby, DE22 3NE, UK.

出版信息

Clin Nutr. 2024 Aug;43(8):1907-1913. doi: 10.1016/j.clnu.2024.06.034. Epub 2024 Jul 2.

DOI:10.1016/j.clnu.2024.06.034

PMID:38996661

Abstract

BACKGROUND & AIMS: Very-low calorie diets (VLCD) and the glucagon-like peptide-1 receptor agonist (GLP1RA) Semaglutide induce significant weight loss and improve glycaemic control in individuals with type 2 diabetes (T2D). This pilot study was conducted to explore the comparative short-term effects of these interventions individually, and in combination, on weight, body composition and metabolic outcomes.

METHODS

Thirty individuals with T2D (age 18-75 years, BMI 27-50 kg m) were randomly assigned to receive Semaglutide (SEM), 800 kilocalorie/day VLCD (VLCD), or both in combination (COMB) for 12 weeks. Measurement of weight and glycated haemoglobin (HbA1c), dual energy X-ray absorptiometry, and intravenous glucose tolerance tests (IVGTT) were performed at baseline and post-intervention. Diet diaries were utilised to assess compliance. Insulin first phase response during IVGTT provided a marker of pancreatic beta-cell function, and insulin sensitivity was estimated using HOMA-IR.

RESULTS

Significantly greater reductions in body weight and fat mass were observed in VLCD and COMB, than SEM (p < 0.01 v both). VLCD and COMB resulted in a 5.4 and 7 percentage-point greater weight loss than SEM, respectively. HbA1c and fasting glucose reduced significantly in all groups, however fasting insulin and HOMA-IR improved in VLCD and COMB only. Insulin first phase response during IVGTT increased in SEM and COMB, and this increase was significantly greater in COMB than VLCD (p < 0.01).

CONCLUSION

VLCD elicited greater short-term losses of weight and fat mass than Semaglutide. Adding VLCD to Semaglutide stimulated further weight loss than Semaglutide alone. The combination did not yield any additive effects on weight and body composition above VLCD alone, but did provoke greater improvements in pancreatic beta-cell function. Thus, combination of Semaglutide and VLCD warrants further exploration as a novel approach to T2D management.

摘要

背景与目的

极低卡路里饮食（VLCD）和胰高血糖素样肽-1 受体激动剂（GLP1RA）司美格鲁肽可显著减轻体重并改善 2 型糖尿病（T2D）患者的血糖控制。本研究旨在探讨这些干预措施单独和联合应用于体重、身体成分和代谢结局的短期比较效果。

方法

30 名 T2D 患者（年龄 18-75 岁，BMI 27-50 kg/m²）被随机分配接受司美格鲁肽（SEM）、800 千卡/天 VLCD（VLCD）或两者联合（COMB）治疗 12 周。在基线和干预后测量体重和糖化血红蛋白（HbA1c）、双能 X 线吸收法（DXA）和静脉葡萄糖耐量试验（IVGTT）。使用饮食日记评估依从性。IVGTT 中的胰岛素第一时相反应提供了胰岛β细胞功能的标志物，使用 HOMA-IR 估计胰岛素敏感性。

结果

与 SEM 相比，VLCD 和 COMB 显著降低体重和体脂（p<0.01）。VLCD 和 COMB 分别使体重减轻 5.4%和 7.0%，明显优于 SEM。所有组的 HbA1c 和空腹血糖均显著降低，但只有 VLCD 和 COMB 组的空腹胰岛素和 HOMA-IR 改善。SEM 和 COMB 的 IVGTT 中胰岛素第一时相反应增加，COMB 比 VLCD 增加更显著（p<0.01）。

结论

VLCD 比司美格鲁肽更能在短期内减轻体重和体脂。在司美格鲁肽的基础上添加 VLCD 可进一步减轻体重，效果优于单独使用司美格鲁肽。联合治疗在体重和身体成分方面没有优于单独使用 VLCD 的附加效果，但确实能更大程度地改善胰岛β细胞功能。因此，司美格鲁肽与 VLCD 的联合应用值得进一步探索，作为 T2D 管理的一种新方法。