在大型队列数据库中，接受肠促胰素或胰岛素治疗的2型糖尿病患者减肥、血糖控制、和心血管生物标志物的变化

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

Abstract

在大型队列数据库中，接受肠促胰素或胰岛素治疗的2型糖尿病患者减肥、血糖控制、和心血管生物标志物的变化海南医学院附属医院内分泌科王新军

OBJECTIVE 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.
目的：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）受体激动剂与减肥相关并对心血管危险因素的生物标志物具有潜在的有利影响；但有这些影响是否在临床试验之外存在，数据仍然有限。
RESEARCH DESIGN AND METHODS 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.

研究设计和方法：从通用电子中心研究数据库收集病例资料进行回顾性分析，评估2型糖尿病起始艾塞那肽、西格列汀或胰岛素在体重减轻、血糖控制和血压及血脂的改变中的相关性。评估基线和随访（90～365）体重、糖化血红蛋白、空腹血糖（FBG）、血压、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇以及总胆固醇。
RESULTS 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.

结果：共有6280、5861和32398例分别接受艾塞那肽、西格列汀或胰岛素治疗的患者被纳入分析。艾塞那肽治疗的患者体重降低3.0 ± 7.33 kg，西格列汀治疗的患者下降1.1 ± 5.39kg，胰岛素治疗的患者体重增加0.6 ± 9.49 kg。仅在在艾塞那肽组体重减轻与糖化血红蛋白及空腹血糖水平降低之间具有明显相关性，在所有治疗组与血压下降之间有显著相关性。体重减轻与血脂改善有一定的相关性，这种相关性主要是在GLP - 1受体激动剂组，胰岛素组的相关性小。
CONCLUSIONS 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.

结论：GLP - 1受体激动剂治疗后的体重减轻与心血管危险因素谱向更有益的方向转变有关。需要进行结局试验，以确定在2型糖尿病患者是否存在生物标志物的改善可转换成心血管事件减少。