Comparison of exenatide and acarbose on intra-abdominal fat content in patients with obesity and type-2 diabetes: A randomized controlled trial

• Published in: Obesity research & clinical practice 2017-09, Vol.11 (5), p.607-615
• Main Authors: Shi, Li, Zhu, Jing, Yang, Ping, Tang, Xiaoqiang, Yu, Wenlong, Pan, Changjie, Shen, Moyu, Zhu, Dalong, Cheng, Jinluo, Ye, Xinhua
• Format: Article
• Language: English
• Subjects: Acarbose - therapeutic use; Adiponectin - blood; Adolescent; Adult; Aged; Blood Glucose - metabolism; Body Mass Index; Body Weight; Diabetes Mellitus, Type 2 - drug therapy; Endocrinology & Metabolism; Endpoint Determination; Exenatide; Female; Glycated Hemoglobin A - metabolism; Humans; Hypoglycemic Agents - therapeutic use; Inflammatory factors; Insulin - blood; Insulin Resistance; Interleukin-6 - blood; Internal Medicine; Intra-abdominal fat; Intra-Abdominal Fat - drug effects; Leptin - blood; Male; Metformin - therapeutic use; Middle Aged; Obesity - drug therapy; Peptides - therapeutic use; Tumor Necrosis Factor-alpha - blood; Type-2 diabetes; Venoms - therapeutic use; Waist Circumference; Young Adult
• ISSN: 1871-403X; 1878-0318
• DOI: 10.1016/j.orcp.2017.01.003

Summary Objective To investigate exenatide, a GLP-1 analogue, compared with acarbose, for intra-abdominal fat reduction in patients with obesity and type-2 diabetes. Methods This randomized controlled trial included 36 patients with obesity and type-2 diabetes, who were metformin-unresponsive, receiving metformin/exenatide (GLP-1 group) or metformin/acarbose (control group) for 3 months. Primary end-point: intra-abdominal fat content from baseline to 3 months; Secondary end-points: changes in fasting blood glucose, glycated haemoglobin (HbAlc), fasting insulin, blood lipids, weight, body mass index, and inflammatory cytokines from baseline to 3 months. Results Intra-abdominal fat content decreased in the GLP-1 group from baseline to 3 months (17,947 ± 5804; 13,717 ± 3628 mm2 , P = 0.001, respectively), but was not significantly reduced in the control group (P = 0.197) and at 3 months post-treatment, it was significantly lower in the GLP-1 group than control group (P = 0.043). Glucose control, measured by HbA1c (GLP-1: 9.72 ± 1.38; 7.09 ± 0.60%, P < 0.001, 9.46 ± 1.25; 7.42 ± 0.84%, P < 0.001, respectively) and insulin resistance index LN(HOMA-IR) (GLP-1: 1.58 ± 0.40; 1.01 ± 0.33, P < 0.001, Control: 1.53 ± 0.57; 1.10 ± 0.33, P = 0.003, respectively) significantly improved in both groups with no significant difference between them. TNF-α, IL-6, and leptin were lower and adiponectin levels higher in the GLP-1 group at 3 months compared with baseline (all P < 0.05), but not significantly changed in the control group. TNF-α, IL-6 and leptin levels were similar between groups. Adiponectin level was higher in the GLP-1 group than the control group at 3 months (P = 0.025). Conclusion Combined exenatide/metformin reduced intra-abdominal fat content, and enhanced insulin resistance and inflammatory status in patients with obesity and type-2 diabetes, representing a novel treatment regimen.