| OBJECTIVE:In this paper,through discussing abdominal obesity and adult patients with type 2 diabetes insulin resistance and secretion of correlation,In order to look for abdominal obesity with type 2 diabetes patients with poor glycemic control influence factors.At the same time,to evaluate the clinical efficacy and adverse reactions of exenatide and insulin for obese type 2 diabetic patients on oral antidiabetic drugs with poor glycemic control.The Meta-analysis were performed using RevMan 5.3 software to evaluate the clinical efficacy and adverse reactions of exenatide and insulin for obese type 2 diabetic patients on oral antidiabetic drugs with poor glycemic control.In order to better clinical treatment of diabetes and related complications and related risk factors of strategy to provide more objective basis.METHODS:200 adult patients with type 2 diabetes collected in the affiliated hospital of Qingdao university from January 2015 to June 2015.Satisfy the following conditions:①:Age greater than or equal to the age of 18 adult patients.② The diagnosis of type 2 diabetes refer to《Chinese type 2 diabetes prevention guide》(the edition of 2013).③ Abdominal obesity standard refer to《China’s obesity data summary analysis of the working party》,BMI>25 kg/m2,Male waistline>90cm;women waistline>85cm.According to all patients waist level were divided into abdominal obesity group and non abdominal obesity group,to collect the two groups of patients according to the hospitalization history information.The patient’s height、Weight、waist、blood pressure、fasting plasma glucose(FBG)、fasting c-peptide、fasting insulin(Fins were determined,and insulin resistance and secretion index were calculated.SPSS 17.0 statistical software was used to analysis,the data to x±s.The difference was statistically significant(P<0.05).The object of study for January 2015-September 2015 our hospital endocrinology hospital treatment of oral hypoglycemic drugs of 80 patients with type 2 diabetes.Satisfy The first chapter conditions and the person have poor effect after changes in lifestyle and oral glucose-lowering drugs after treatment(HbAlc>7.5%,fasting glucose>8 mmol/L);According to the completely random method selected patients divided into the Exenatide group and insulin group,All patients by changes in lifestyle and oral metformin or sulfonylureas drugs to keep blood sugar under control,and the experimental group 4 weeks before the daily dinner earlier 1 h to Exenatide 5ug hypodermic,depending on the situation after five weeks after starting treatment dose adjustment for 10 ugevery time;The control group used insulin glargine10 u,1/d,subcutaneous injection before sleep.And according to the situation of glycemic control in patients with adjustment of insulin dosage,to maintain blood glucose in FPG<7.1 mmol/L,2hPG<10.0mmol/L,theobservation time is 26 weeks.To observe and record waist、height、hip circumference、Fasting plasma glucose(FPG)、glycosylated hemoglobin(Hb1lc)、weight、systolic blood pressure(SBP),diastolic blood pressure(DBP),low density lipoprotein(LDL),high-density lipoprotein(HDL),triglycerides(TG),and other related indicators,calculate BMI、insulin secretion index(HOMA-B)、indexes of insulin resistance(HOMA-IR)and waist-to-hip ratio(WHR),and other indicators,at the same time record adverse reactions occurin the process of treatment in patients Used SPSS 17.0 statistical software to analyze data,The difference was statistically significant(P<0.05).According to the research purpose to set up the screening of related literature and exclusion criteria;formulatethe searching strategy,through PubMed、the Chinese Biological Medicine Datebase(CBM)、CNKI、Wanfang Data Knowledge Service Platform、VIP to retrieve all theliterature selection ofefficacy and safety by Exenatide oral hypoglycemic drugs and insulin therapy of obese type 2 diabetes mellitus.choose met inclusion exclusion criteria,the data information complete randomized controlled trial(RCT)as the research object;Apply to the international commonly used Jadad score method to evaluate quality included in the test;To process the relevant data in the test;Apply the ReviewManager 5.1 software to analysis the extractedresearch data.Analysis the results and put forwardconclusions.RESULTS:In patients with type 2 diabetes,abdominal obesity group,fasting C peptide,fasting insulin and insulin resistance index was significantly higher than that of non abdominal obesity group(P<0.05).Fasting plasma glucose,insulin secretion index,glucose disposal ability in the two groups of patients with no statistical difference(P>0.05).Multi-factor unconditioned logistic regression analysis showed that influence of abdominal obesity with type 2 diabetes with age and BMI,HbAlc,islet secretion were positively correlated,and negatively correlated with glucose disposal ability and creatinine.After treatment:① two groups of hypoglycemiceffect comparison:two group of FPG compared with before treatment were improved significantly,at the same time,the insulin group is more significant.But in HbAlc indicators,Exenatide group compared with insulin group was no statistically significant difference② Pancreatic islet function and insulin resistance:Exenatide group significantly increased HOMA-B before and after the treatment,but no obvious difference before and after the change of insulin treatment group In the HOMA-IR indicators,Exenatide group before and after treatment significantly reduce the HOMA-IR,and insulin group,no significant difference before and after treatment.③ Two groups to control cardiovascular risk factors:the DBP TG,index of HDL and differences between the two groups before and after treatment and the differences between the two groups was not significant,but SBP LDL indicators,Exenatide group decreased significantly after treatment,statistically significant difference(P<0.05).④ Quality:Exenatide group weight and BMI were significantly reducedbefore and aftertreatment,statistically significant difference(P<0.05),while insulin group,no significant difference before and after treatment,but Exenatide group weight and BMI significantly lower than insulin groupafter treatment,difference has statistical significance(P<0.05).⑤ Adverse reaction:In the two groups there was no statistical difference in complications meaning(P>0.05).Participants included 11 RCT,meta analysis results showed that compared with the Exenatide,in terms of reducing fasting glucose,insulin effect more apparent[MD = 0.35,95%CI:(0.11,0.59),P =0.004)].In control effect of glycosylated hemoglobin,there was no statistically significant difference[MD=-0.04,95%CI:(-0.20,0.11),P=0.58],between Exenatide and insulin.Compared with the insulin,Exenatide reduce BMI more apparent[MD=-2.77,(95%CI:-3.34,-2.20),P<0.00001];Compared with the insulin,Exenatide reduce insulin resistance index,the effect is more obvious[MD=-1.67,95%CI:(-1.93,-1.41),P<0.00001];Adverse reaction in the process of treatment,the insulin is more likely to lead to hypoglycemia,[OR = 0.32,95%CI:0.19,0.54),P<0.0001];While Exenatide are more likely to lead to gastrointestinal adverse reaction[OR = 4.04,95%CI:2.35,6.93),P<0.00001).CONCLUSIONS:In patients with type 2 diabetes,abdominal obesity group,fasting C peptide,fasting insulin and insulin resistance index was significantly higher than that of non abdominal obesity group.Fasting plasma glucose,insulin secretion index,glucose disposal ability in the two groups of patients with no statistical difference.Multi-factor unconditioned logistic regression analysis showed that influence of abdominal obesity with type 2 diabetes with age and BMI,HbAlc,islet secretion were positively correlated,and negatively correlated with glucose disposal ability and creatinine.For obese type 2 diabetic patients on oral antidiabetic drugs with poor glycemic control,exenatide can achieve the same hypoglycemic comtrol comparing with application of insulin treatment,besides it has more advantages in improving weight control.Also above results were confirmed by Meta analysis system evaluation. |
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