Abstract
In China, most normal BMI (body mass index of ≥18.5 to <25 kg/m2) adults with type 2 diabetes (T2DM) exhibit visceral adiposity. This study compared the effects of exenatide and humalog Mix25 on normal BMI patients with T2DM and visceral adiposity. A total of 95 patients were randomized to receive either exenatide or humalog Mix25 treatment for 24 weeks. Subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were quantified by magnetic resonance imaging (MRI) and liver fat content (LFC) by liver proton magnetic resonance spectroscopy (1H MRS). Each patient's weight, waist circumference, BMI, blood glucose, insulin sensitivity, pancreatic β-cell function, and fibroblast growth factor 21 (FGF-21) levels were measured. Data from 81 patients who completed the study (40 and 41 in the exenatide and humalog Mix25 groups, respectively) were analysed. The change in 2 h plasma blood glucose was greater in the exenatide group (P = 0.039). HOMA-IR and MBCI improved significantly after exenatide therapy (P < 0.01, P = 0.045). VAT and LFC decreased in both groups (P < 0.01 for all) but to a greater extent in the exenatide group, while SAT only decreased with exenatide therapy (P < 0.01). FGF-21 levels declined more in the exenatide group (P < 0.01), but were positively correlated with VAT in the entire cohort before (r = 0.244, P = 0.043) and after (r = 0.290, P = 0.016) the intervention. The effects of exenatide on glycaemic metabolism, insulin resistance, pancreatic β-cell function, and fat deposition support its administration to normal BMI patients with T2DM and visceral adiposity.
Highlights
Diabetes and obesity are primary risk factors for cardiovascular disease (CVD), the leading causes of morbidity and mortality worldwide
Comparisons between European and Chinese populations indicate that normal BMI Chinese adults more frequently exhibit abdominal visceral adiposity than European adults do at a given waist circumference (WC) [2, 3]
Considering that Nonalcoholic fatty liver disease (NAFLD) is common among nonobese patients with type 2 diabetes mellitus (T2DM) [12], Journal of Diabetes Research treatments that control blood glucose and glycated haemoglobin (HbA1c) levels while reducing visceral adipose tissue (VAT) and liver fat content (LFC) are urgently needed
Summary
Diabetes and obesity are primary risk factors for cardiovascular disease (CVD), the leading causes of morbidity and mortality worldwide. Clinical studies have demonstrated that GLP-1RAs can effectively control blood glucose, induce weight loss, protect pancreatic β-cells, decrease visceral and hepatic fat deposits, and improve overall and hepatic insulin sensitivity in obese patients with T2DM and prediabetes [13, 14].
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