Greater improvement in insulin sensitivity per unit weight loss associated with tirzepatide versus semaglutide: An exploratory analysis

赛马鲁肽 医学 内科学 减肥 重量变化 胰岛素 内分泌学 胰岛素敏感性 2型糖尿病 体重增加 餐后 安慰剂 胰岛素抵抗 糖尿病 体重 肥胖 利拉鲁肽 替代医学 病理
作者
Kieren J. Mather,Andrea Mari,Govinda J. Weerakkody,Tim Heise,J. Hans DeVries,Shweta Urva,Tamer Coşkun,Zvonko Miličević,Axel Haupt,Melissa K. Thomas
出处
期刊:Diabetes, Obesity and Metabolism [Wiley]
卷期号:27 (3): 1507-1514
标识
DOI:10.1111/dom.16159
摘要

Abstract Aims To explore the relationship between weight loss and insulin sensitivity in response to tirzepatide or semaglutide. Materials and Methods We conducted a post hoc exploratory analysis of a 28‐week, double‐blind, randomized trial in people with type 2 diabetes treated with metformin, randomized to tirzepatide 15 mg, semaglutide 1 mg or placebo. We evaluated the relationship between change in body weight and change in insulin sensitivity determined from hyperinsulinemic euglycemic clamp ( M value), or from mixed‐meal tolerance testing (Matsuda index). Results Tirzepatide was associated with a greater improvement than semaglutide in insulin sensitivity assessed using hyperinsulinemic euglycemic clamps ( p < 0.001). With tirzepatide, improvements in insulin sensitivity were associated with percent change in weight ( R = −0.656, p < 0.0001). With semaglutide, change in insulin sensitivity was less strongly correlated with percent change in weight ( R = −0.268, p = 0.0820; p = 0.0242 vs. tirzepatide). In regression analyses, the slope of the relationship between change in M value and change in weight was statistically different between semaglutide and tirzepatide ( p = 0.0461). These relationships were also assessed using the Matsuda index as the metric of insulin sensitivity, and using change in fat mass as the determinant of change in insulin sensitivity. Conclusions Improvement in insulin sensitivity was proportional to weight and fat loss, with greater strength of association with tirzepatide. In regression analysis, tirzepatide was associated with greater improvement in insulin sensitivity per unit weight loss than semaglutide. The greater improvement in insulin sensitivity following treatment with tirzepatide was not simply attributable to greater weight or fat loss.
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