Effects Of Exenatide On Liver Fat Content And Serum Chemerin Level In Obese Type 2 Diabetes Mellitus Patients

Objective To evaluate the effects of exenatide on the plasma glucose, liver fat content and serum chemerin in obese patients with type 2 diabetes mellitus(T2DM) and non-alcoholic fatty liver disease(NAFLD).Methods 60 cases of obese patients with T2 DM and NAFLD who were unable to achieve better glycemic control with diet control, exercise and oral anti-diabetes agents for at least 3 month were randomly divided into two groups. One group was treated by exenatide(10ug twice daily), the other group was treated by insulin glargine(the starting dose was 0.2U/kg or 6-10U) for 12 weeks. The change of body weight(BW), body mass index(BMI), fasting plasma glucose(FPG), glycosylated hemoglobin(Hb A1c), 2 hours plasma glucose(2h PG), blood lipid(TG、TC、HDL、LDL), insulin resistance index(HOMA-IR), liver enzyme index(ALT, AST) and serum chemerin level were measured; the change of liver fat content(LFC) were quantitated by ultrasound.Result(1)10 cases of exenatide group have mild gastrointestinal reaction(include nausea, vomiting and diarrhea), 1 case fall off because of intolerance, 1 case was lost to follow-up; in the control group two cases was lost to follow-up, eventually 56 subjects accomplished observation.(2) The levels of the BW, BMI and WHR in the exenatide group were significantly declined in comparison with the control group after treatment(P<0.01); the Hb A1 c decreased by 1.07% and 1.02%, the FPG decreased by1.49mmol/L and 1.06mmol/L, the 2h PG decreased by 4.16mmol/L and 2.63mmol/L(P<0.05) in exenatide and control group; the levels of TG, ALT, AST were declined in the exenatide group(P<0.05); the FINS and HOMA-IR were declined in the exenatide group compared with the control group(P<0.01); the levels of chemerin[(170.30±17.99)VS(142.67±17.45)] was declined in the exenatide group, the control group has descending trends[(163.53±16.80)VS(151.61±24.85)](P>0.05); the LFC decreased by 2.85%(P<0.05) and 1.38%(P>0.05) in the exenatide and control group.(3)Correlation analysis showed that BMI(r=0.412,P<0.05)、TG(r=0.398,P<0.05)、HOMA-IR(r=0.547,P<0.05) and chemerin(r=0.386,P<0.05)were associated with the LFC. The decrease of the decrease of TG and HOMA-IR were independently impact factors for LFC by multiple stepwise regression analysis.Conclusion Exenatide can improve the glucolipid metabolism, liver function, reduce body weight,LFC and serum chemerin level at the same time, which may be the effective drugs for the treatment of T2 DM with NAFLD.