Effects of liraglutide on sleep-disordered breathing and diabetic microangiopathy in patients with type 2 diabetes mellitus and obstructive sleep apnea-hypopnea syndrome

Objective To investigate the effects of glucagon-like peptide-1 analogs on sleep-disordered breathing and diabetic microangiopathy in patients with type 2 diabetes mellitus and obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods A total of 239 patients with T2DM in the Department of Endocrinology and Sleep Center of Henan Provincial People′s Hospital were collected for polysomnography monitoring and diabetic microangiopathy screening from January 2017 to December 2018. A total of 93 patients with T2DM and OSAHS were included, who were diagnosed with diabetic microangiopathy, 50 patients treated with liraglutide as the treatment group, and 43 patients treated with conventional hypoglycemic drugs as the control group. After 6-month treatment, changes of body mass index, waist circumference, HbA1c, blood pressure, lipid profile, uric acid, apnea hypopnea index and the improvement of diabetic microangiopathy in the two groups were compared. Student-t test, Rank-sum test or Chi-square test were used for comparison between the two groups. ANCOVA and partial correlation analysis were used to evaluate the correlation between each index and AHI variation value. Multivariate Logistic regression analysis was used to analyze the correlation between liraglutide and the improvement of diabetic microangiopathy. Results After 6-month treatment, compared with control group, BMI, waist circumference, HbA1c, systolic blood pressure, and AHI were decreased more significantly in treatment group[(-1.85±2.46) vs (0.02±0.46) kg/m2, (-3.24±10.34) vs (-0.07±0.88) cm, (-0.83±0.55)% vs (-0.06±0.40)%,(-7.92±14.16) vs (-0.56±16.16) mmHg (1 mmHg=0.133 kPa) , (-3.16±3.52) vs (0.5±1.54) time/h, t=2.159-7.703, all P<0.05], diabetic microangiopathy was improved more significantly in treatment group [26.0%(13/50) vs 9.3%(4/43), χ2=4.315, P<0.05]. The change in AHI after treatment was positively correlated with changes in BMI, waist circumference and HbA1c (r=0.238, 0.232 and 0.317, all P<0.05), and was negatively correlated with age (r=-0.21, P<0.05). After adjusting for age, duration of diabetes, BMI, waist circumference, HbA1c, and systolic blood pressure, liraglutide was associated with AHI variation value (F=8.155, P=0.005). After adjusting for age, duration of diabetes, BMI, waist circumference, HbA1c, systolic blood pressure, and AHI, multivariate Logistic regression analysis showed that liraglutide could improve diabetic peripheral neuropathy (OR=3.426, 95%CI:1.024-11.460, P=0.046). Conclusion Liraglutide may improve sleep-disordered breathing and diabetic microangiopathy in patients with type 2 diabetes mellitus and obstructive sleep apnea-hypopnea syndrome, but has no effect on diabetic nephropathy and diabetic retinopathy. Key words: Diabetes mellitus, type 2; Sleep apnea, obstructive; Diabetic microangiopathy; Glucagon-like peptide-1