摘要
目的了解二甲双胍和阿卡波糖的降糖疗效与体重下降幅度、中心性肥胖是否相关。方法采用MARCH研究数据库资料,研究对象为来自全国11个研究中心入组的30-70岁初诊2型糖尿病患者共788例。符合方案的患者在经过4周生活方式导入期后随机分配至二甲双胍或阿卡波糖治疗48周。本文分别按基线体质指数(BMI)分为19.0-23.9、24.0-25.9、26.0-27.9、28.0-30.0kg/m24组,或按是否为中心性肥胖(男性腰围≥90cm,女性腰围≥80cm)分为2组,采用协方差分析(ANCOVA)两种药物降糖疗效与BMI和中心性肥胖的关系。结果(1)调整治疗中心、基线糖化血红蛋白(HbA1c)后,阿卡波糖和二甲双胍降低HbA1c幅度与BMI无关[阿卡波糖治疗HbA1c降幅在4组BMI分别为0.98%±0.09%、0.95%±0.09%、1.20%±0.09%、1.14%±0.10%(F=1.80,P >0.05);二甲双胍治疗对应的HbA1c降幅分别为1.08%±0.09%、1.12%±0.09%、1.20%±0.10%、1.32%±0.10%(F=1.25,P >0.05)]。(2)阿卡波糖和二甲双胍降低HbA1c幅度与体重下降幅度有关。(3)二甲双胍降低HbA1c的作用在中心性肥胖的患者较非中心性肥胖者更为显著(1.26%±0.06%比0.98%±0.08%,F=7.68,P<0.05),而阿卡波糖降HbA1c幅度与中心性肥胖无关(1.10%±0.06%比0.97%±0.08%,F=1.62,P >0.05)。结论阿卡波糖降糖疗效与肥胖程度无关,二甲双胍降糖疗效在中心性肥胖患者更好,而与代表整体肥胖的BMI无相关。这可能与二甲双胍能更有效地抑制中心性肥胖患者肝脏葡萄糖过量输出有关。
Objective The purpose of this paper was to understand the association between the efficacy of acarbose or metformin and the parameters reflected body weight, such as body mass index (BMI), central obesity (COB), magnitude of weight loss. Methods A total of 788 participants from MARCH database were included in this analysis. After a 4-week run-in period of lifestyle modification, patients were assigned to 48 weeks of therapy with metformin or acarbose as the initial treatment. The participants were divided into four BMI groups (BMI 19.0-23.9, 24.0-25.9, 26.0-27.9, and 28.0-30.0 kg/m^2) and two central obesity groups according to IDF criteria (i.e. waist circumference ≥90 cm in male, ≥80 cm in female), respectively. ANCOVA was used to assess the association of the above obesity categories with the changes of glycated hemoglobin A1c (HbA1c) from baseline in acarbose group and metformin group respectively, with treatment and center as factors, and baseline HbA1c as a covariate. Results There was no significant difference in change from baseline HbA1c within the acarbose groups (0.98%±0.09%, 0.95%±0.09%, 1.20%±0.09%, 1.14%±0.10%, F=1.80, P >0.05) as well as the metformin groups (1.08%±0.09%, 1.12%±0.09%, 1.20%±0.10%, 1.32%±0.10%, F=1.25, P >0.05) when patients were stratified by BMI quartile. The reduction in HbA1c was greater in patients with central obesity than those without in metformin group (1.26%±0.06% vs 0.98%±0.08%, F=7.68, P<0.05), but there was no significant difference among patients with and without central obesity for HbA1c reduction in acarbose treatment group (1.10%±0.06% vs 0.97%±0.08%, F=1.62, P >0.05). Conclusion The hypoglycemic efficacy of acarbose was not associated with the obesity status. In contrast, metformin was more effective in diabetic patients with central obesity.
作者
王昕
杨兆军
王娜
金仙
张金苹
李照青
张雪莲
杨文英
Wang Xin;Yang Zhaojun;Wang Na;Jin Xian;Zhang Jinping;Li Zhaoqing;Zhang Xuelian;Yang Wenying(Department of Endocrinology,China-Japan Friendship Hospital,Beijing 100029,China)
出处
《中华糖尿病杂志》
CAS
CSCD
北大核心
2018年第12期773-776,共4页
CHINESE JOURNAL OF DIABETES MELLITUS
基金
拜尔医药保健有限公司医学基金.
