Abstract
BackgroundWeight loss, especially fat mass reduction, helps to improve blood glucose control, insulin sensitivity, and β-cell function. This study aimed to compare the effect of exenatide and glargine on body composition in overweight and obese patients with type 2 diabetes (T2DM) who do not achieve adequate glycemic control with metformin.MethodsWe performed a prospective, randomized study of 37 overweight or obese patients with T2DM who had inadequate glycemic control with metformin. The patients were treated with either exenatide or glargine for 16 weeks. Dual-energy X-ray absorptiometry was used to assess body composition.ResultsPost-intervention weight, body mass index (BMI), waist circumference, body mass, and fat mass were lower in patients treated with exenatide, while weight and BMI significantly increased with glargine. Reductions in weight, BMI, body fat mass, and percent fat mass (except for gynoid) were greater with exenatide than with glargine, and percent lean tissue (other than the limbs) increased with exenatide. In all body regions except for the limbs, fat mass decreased with exenatide to a greater extent than lean tissue. Glucose control, insulin resistance, and β-cell function were not different between the treatment groups.ConclusionsFor overweight and obese patients whose T2DM was inadequately controlled with metformin, exenatide and glargine achieved similar improvements in glycemic control, insulin sensitivity, and β-cell function.However, exenatide produced better weight and fat mass reduction, which were beneficial for blood glucose control. Our findings may guide the selection of appropriate drugs for glycemic and weight control.Trial registrationNCT02325960, registered 25 December 2014.
Highlights
Weight loss, especially fat mass reduction, helps to improve blood glucose control, insulin sensitivity, and β-cell function
The exenatide treatment group had greater decreases in body weight (△ = − 4.5 kg; 95% confidence interval (CI), − 6.3 to − 2.7 kg) and body mass index (BMI) (△ = − 1.6 kg/m2; 95%CI, − 2.2 to − 0.9 kg/m2) than the insulin glargine group (P < 0.001) (Table 1)
We found that △total fat mass and percentage △trunk fat mass were correlated with △fasting blood glucose (FBG) (R2 = 0.397, P = 0.002; and R2 = 0.298, P = 0.009, respectively) and that △android fat mass in terms of both mass and percent mass were correlated with △Glycated hemoglobin (HbA1c) (R2 = 0.547, P < 0.001; R2 = 0.454, P = 0.001, respectively)
Summary
Especially fat mass reduction, helps to improve blood glucose control, insulin sensitivity, and β-cell function. This study aimed to compare the effect of exenatide and glargine on body composition in overweight and obese patients with type 2 diabetes (T2DM) who do not achieve adequate glycemic control with metformin. Clinical studies have demonstrated that GLP-1 receptor agonists reduce body weight and visceral and hepatic fat deposits, and improve hepatic insulin sensitivity in obese patients with T2DM [18, 25,26,27]. Exenatide, a GLP-1 receptor antagonist, is associated with a statistically significant reduction in total fat mass, mainly in the trunk [19], whereas the basal insulin glargine reduces liver fat content and improves hepatic insulin sensitivity [28]. Glargine is associated with significantly increased total, trunk, and limb fat mass as well as limb lean tissue [21, 22]
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