Clinical Experience of Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist Combined with Alpha Glucosidase Inhibitor Acarbose on Body Weight and Metabolic Parameters in Patients with Type 2 Diabetes Mellitus

昇糖素類似胜肽併甲型糖苷酶抑制劑治療對第2型糖尿病病人在體重及新陳代謝控制的臨床經驗

10.3966/168232812016122604003

黃珮茹(Pei-Ju Huang)；蘇矢立(Shih-Li Su)；林益卿(I-Ching Lin)；杜思德(Shih-Te Tu)；謝明家(Ming-Chia Hsieh)；許上人(Shang-Ren Hsu)；廖培湧(Pei-Yung Liao)；蔡東華(Dong-Hwa Tsai)；謝芳傑(Hon-Ke Hsieh)；林世鐸(Shi-Dou Lin)；王舒儀(Shu-Yi Wang)；孫宏禹(Hung-Yu Sun)；劉晏孜(Yen-Tze Liu)

diabetes mellitus ； glucagon-like peptide 1 receptor agonist ； exenatide ； alpha glucosidase inhibitor ； acarbose ； body weight reduction ； systolic blood pressure ； 糖尿病 ； 昇糖素類似胜肽 ； 艾塞那肽 ； 甲型糖苷酶抑制劑 ； 醣祿錠

台灣家庭醫學雜誌

26卷4期（2016 / 12 / 01）

208 - 218

英文

Aim: To investigate the effects of glucagon-like peptide-1 receptor agonist (GLP-1 RA) combined with alpha glucosidase inhibitor acarbose on body weight (BW) and metabolic parameters in patients with type 2 diabetes mellitus (T2DM). Methods: Participants in this retrospective study comprised 126 patients with T2DM treated at Changhua Christian Hospital, Taiwan from 2012 to 2013. Patients received either exenatide, a GLP-1 RA, combined with acarbose (n=106) or exenatide only (n=20) for 12 months. Data at the beginning and the end of study period, including BW, body mass index (BMI), duration of diabetes, fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), systolic blood pressure (SBP), serum lipid and lipoprotein, were extracted from medical records. Regression model was calculated by generalized estimating equations (GEE). Results: After 12 months, patients treated with the combined regimen had significant reductions in BW, BMI, HbA1c, FBG and SBP (p＜0.05). The Exenatide alone group had significant decrease in FBG. In the adjusted model, both groups together had significant reductions of BW, HbA1c and SBP, but the combined therapy group achieved significantly greater SBP reduction than the exenatide alone group (p＜0.05). Conclusion: Exenatide combined with acarbose achieved significant improvements in more metabolic parameters than exenatide alone within one year of therapy. In particular, acarbose may augment the BP lowering effect of exenatide.

目的：此研究目標為比較第2型糖尿病病人使用昇糖素類似胜肽與昇糖素類似胜肽合併甲型糖苷酶抑制劑艾塞那肽在體重減輕及新陳代謝指數影響的差異性。方法：回溯性收集彰化基督教醫院西元2012年至2013年期間126位第2型糖尿病病人使用昇糖素類似胜肽藥物長達一年，分成20位病人使用昇糖素類似胜肽及其他非艾塞那肽的血糖藥物，其餘106位使用昇糖素類似胜肽加上艾塞那肽合併治療，紀錄並比較治療一年後體重、身體質量指數、飯前血糖、糖化血色素、收縮壓及血脂肪的變化。回歸分析是使用廣義估計方程式。結果：追蹤12個月後，結果顯示合併艾塞那肽治療組有顯著的減少體重、身體質量指數、糖化血色素、飯前血糖及收縮壓；單獨使用昇糖素類似胜肽者有顯著減少飯前血糖。經過多元回歸分析調整後，兩組別在體重、糖化血色素及收縮壓都有顯著的下降；而兩組別相互比較下，合併艾塞那肽治療組比起使用昇糖素類似胜肽及其他非艾塞那肽者的收縮壓有顯著的下降。結論：昇糖素類似胜肽併用艾塞那肽治療比起併用其他非艾塞那肽的血糖藥物對於第2型糖尿病肥胖病人血壓控制有加成的效果。

1. Bashier, AM,Abdelgadir, EI,Khalifa, AA,Rashid, F,Abuelkeir, SM,Bachet, FE(2014).Exenatide's effect in reducing weight and glycosylated hemoglobin level in an arab population with type 2 diabetes.Saudi Med J,35,1404-7.
2. Bolen, S,Feldman, L,Vassy, J(2007).Systematic review: Comparative effectiveness and safety of oral medications for type 2 diabetes mellitus.Ann Intern Med,147,386-99.
3. Cornell, S(2012).Differentiating among incretin therapies: A multiple target approach to type 2 diabetes.J Clin Pharm Ther,37,510-24.
4. Domecq, JP,Prutsky, G,Leppin, A(2015).Clinical review: Drugs commonly associated with weight change: a systematic review and meta-analysis.J Clin Endocrinol Metab,100,363-70.
5. Dupre, J,Behme, MT,Hramiak, IM(1995).Glucagon-like peptide I reduces postprandial glycemic excursions in IDDM.Diabetes,44,626-30.
6. Hansotia, T,Maida, A,Flock, G(2007).Extrapancreatic incretin receptors modulate glucose homeostasis, body weight, and energy expenditure.J Clin Invest,117,143-52.
7. Hoffmann, J,Spengler, M(1997).Efficacy of 24-week monotherapy with acarbose, metformin, or placebo in dietary-treated NIDDM patients: The essen-II study.Am J Med,103,483-90.
8. Kalra, S,Sahay, RK,Schnell, O(2013).Acarbose improves glycemic control and reduces body weight: Subanalysis data of south asia region.Indian J Endocrinol Metab,17(Suppl 1),S304-6.
9. Kishimoto, M,Noda, M(2014).Effects of exenatide in a morbidly obese patient with type 2 diabetes.Diabetes Ther,5,323-32.
10. Li, Y,Tong, Y,Zhang, Y,Huang, L,Wu, T,Tong, N(2014).Acarbose monotherapy and weight loss in eastern and western populations with hyperglycaemia: an ethnicity-specific meta-analysis.Int J Clin Pract,68,1318-32.
11. McCarty, MF,DiNicolantonio, JJ(2015).Acarbose, lente carbohydrate, and prebiotics promote metabolic health and longevity by stimulating intestinal production of GLP-1.Open Heart,2(1),e000205.
12. Ranganath, L,Norris, F,Morgan, L,Wright, J,Marks, V(1998).Delayed gastric emptying occurs following acarbose administration and is a further mechanism for its anti hyperglycaemic effect.Diabetic Med,15,120-4.
13. Shaw, J,Sicree, R,Zimmet, P(2010).Global estimates of the prevalence of diabetes for 2010 and 2030.Diabetes Res Clin Pract,87,4-14.
14. Van, L,Scheen, A(2015).Weight management in type 2 diabetes: current and emerging approaches to treatment.Diabetes Care,38,1161-72.
15. Wysham, CH,MacConell, LA,Maggs, DG,Zhou, M,Griffin, PS,Trautmann, ME(2015).Five-Fiveyear efficacy and safety data of exenatide once weekly: Long-term results from the DURATION-1 randomized clinical trial.Mayo Clin Proc,90,356-65.
16. Yang, W,Liu, J,Shan, Z(2014).Acarbose compared with metformin as initial therapy in patients with newly diagnosed type 2 diabetes: An open-label, non-inferiority randomised trial.Lancet Diabetes Endocrinol,2,46-55.
17. Zheng, MY,Yang, JH,Shan, CY(2013).Effects of 24-week treatment with acarbose on glucagon-like peptide 1 in newly diagnosed type 2 diabetic patients: a preliminary report.Cardiovasc Diabetol,12,73.