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

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

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。

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.