Weight loss, glycemic control, and changes in cardiovascular biomarkers in patients with type 2 diabetes receiving incretin therapies or insulin in a large cohort database.
Weight loss, glycemic control, and changes in cardiovascular biomarkers in patients with type 2 diabetes receiving incretin therapies or insulin in a large cohort database.
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DOI：
10.2337/dc09-2062
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发表时间：
2010-08
期刊：
影响因子：
16.2
通讯作者：
Berria R
中科院分区：
文献类型：
--
作者：
Horton ES;Silberman C;Davis KL;Berria R
2型糖尿病患者减肥可以改善血糖控制，降低血压，改善血脂异常。胰高血糖素样肽（GLP-1）受体激动剂与体重减轻相关，并对心血管风险生物标志物具有潜在的有益作用;然而，有有限的信息表明这些作用是否仍在临床试验之外。回顾性分析来自General Electric Centricity研究数据库的医疗记录，以评估开始使用艾塞那肽、西格列汀或胰岛素治疗的2型糖尿病患者体重减轻与血糖控制以及血压和血脂变化之间的关系。评估基线和随访（索引日期后90-365天）的体重、A1 C、空腹血糖（FBG）、血压、甘油三酯、LDL、HDL和总胆固醇。分别有6，280、5，861和32，398例接受艾塞那肽、西格列汀或胰岛素治疗的患者被纳入分析。艾塞那肽治疗患者体重减轻的平均值± SD为3.0 ± 7.33 kg，西格列汀治疗患者体重减轻1.1 ± 5.39 kg，胰岛素治疗患者体重增加0.6 ± 9.49 kg。体重减轻与A1 C和FBG降低之间存在显著相关性，仅使用exenetrin，所有治疗均降低血压。体重减轻与血脂的一些改善相关，主要是在GLP-1受体激动剂组，与胰岛素组几乎没有相关性。GLP-1受体激动剂的体重减轻与向更有利的心血管风险特征转变相关。需要进行结局试验以确定生物标志物的改善是否转化为2型糖尿病患者心血管事件的减少。
Weight loss in patients with type 2 diabetes can improve glycemic control, lower blood pressure, and improve dyslipidemia. Glucagon-like peptide (GLP-1) receptor agonists are associated with weight loss and have potentially beneficial effects on cardiovascular risk biomarkers; however, there is limited information to indicate whether these effects remain outside of clinical trials. Medical records from the General Electric Centricity research database were analyzed retrospectively to evaluate the relationship between weight loss and glycemic control and changes in blood pressure and lipids in patients with type 2 diabetes initiating therapy with exenatide, sitagliptin, or insulin. Baseline and follow-up (90–365 days after the index date) for weight, A1C, fasting blood glucose (FBG), blood pressure, triglycerides, and LDL, HDL, and total cholesterol were assessed. A total of 6,280, 5,861, and 32,398 patients receiving exenatide, sitagliptin, or insulin, respectively, were included in the analysis. Exenatide-treated patients lost a mean ± SD of 3.0 ± 7.33 kg, sitagliptin-treated patients lost 1.1 ± 5.39 kg, and insulin-treated patients gained 0.6 ± 9.49 kg. There was a significant association between weight loss and a reduction in A1C and FBG with exenatide only and a reduction in blood pressure for all therapies. Weight loss was associated with some improvements in lipids, primarily in the GLP-1 receptor agonist group, with little association in the insulin group. Weight reduction with GLP-1 receptor agonists was associated with a shift toward a more favorable cardiovascular risk profile. Outcome trials are needed to determine whether improvement in biomarkers translates into a reduction in cardiovascular events in patients with type 2 diabetes.
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