Exenatide or glimepiride added to metformin on metabolic control and on insulin resistance in type 2 diabetic patients
Exenatide or glimepiride added to metformin on metabolic control and on insulin resistance in type 2 diabetic patients
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DOI：
10.1016/j.ejphar.2011.05.051
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发表时间：
2011-09-01
影响因子：
5
通讯作者：
Maffioli, Pamela
中科院分区：
文献类型：
--
作者：
Derosa, Giuseppe;Putignano, Pietro;Maffioli, Pamela
本研究的目的是评价艾塞那肽与格列美脲对服用二甲双胍的2型糖尿病患者体重、血糖控制和胰岛素抵抗的影响。111例未控制的2型糖尿病患者对二甲双胍最高剂量（2500-3000 mg/天）不耐受。在一项随机、单盲、对照研究中，患者随机接受艾塞那肽5 μ g，每天2次或格列美脲1 mg，每天3次，1个月后滴定为艾塞那肽10 μ g，每天2次或格列美脲2 mg，每天3次，持续12个月。我们在基线和3、6、9和12个月后评估这些参数：体重、体重指数（BMI）、HbA（1c）、血糖控制、空腹血浆胰岛素、稳态模型评估胰岛素抵抗指数（HOMA-IR）指数、脂联素、肿瘤坏死因子- α和高敏c反应蛋白。两种治疗方法对血糖控制的改善效果相似，两组之间没有任何差异。只有艾塞那肽能降低BMI、胰岛素抵抗参数（如空腹血浆胰岛素、HOMA-IR、脂联素）和炎症参数（如肿瘤坏死因子- α、高敏c反应蛋白）。此外，艾塞那肽获得的值明显优于格列美脲记录的值。由此可见，在改善胰岛素抵抗和炎症状态方面，艾昔南德优于格列美脲。此外，脂联素增加和肿瘤坏死因子- α减少似乎与艾塞那肽获得的体重减轻有关。(C) 2011 Elsevier B.V.版权所有
The aim of this study was to evaluate the effect of exenatide compared to glimepiride on body weight, glycemic control and insulin resistance in type 2 diabetic patients taking metformin. One hundred and eleven patients with uncontrolled type 2 diabetes mellitus and intolerant to metformin at the highest dosages (2500-3000 mg/day) were enrolled in this study. Patients were randomized to receive exenatide 5 mu g twice a day or glimepiride 1 mg three times a day and titrated after 1 month to exenatide 10 mu g twice a day or glimepiride 2 mg three times a day for 12 months in a randomized, single-blind, controlled study. We evaluated at the baseline and after 3, 6, 9, and 12 months these parameters: body weight, body mass index (BMI), HbA(1c), glycemic control, fasting plasma insulin, homeostasis model assessment insulin resistance index (HOMA-IR) index, adiponectin, tumor necrosis factor-alpha, and high sensitivity-C reactive protein. Both treatments gave a similar improvement of glycemic control, without any differences between the two groups. Only exenatide gave a decrease of BMI, insulin resistance parameters such as fasting plasma insulin, HOMA-IR, and adiponectin and a decrease of inflammatory parameters such as tumor necrosis factor-alpha, and high sensitivity-C reactive protein. Furthermore, the values obtained with exenatide were significantly better than the values recorded with glimepiride. We can conclude that exenande was better than glimepiride in improving insulin resistance and inflammatory state. Furthermore, adiponectin increase, and tumor necrosis factor-alpha reduction seem to be related to weight loss obtained with exenatide. (C) 2011 Elsevier B.V. All rights reserved.