Comparison of exenatide and acarbose on intra-abdominal fat content in patients with obesity and type-2 diabetes: A randomized controlled trial

To investigate exenatide, a GLP-1 analogue, compared with acarbose, for intra-abdominal fat reduction in patients with obesity and type-2 diabetes. This randomized controlled trial included 36 patients with obesity and type-2 diabetes, who were metformin-unresponsive, receiving metformin/exenatide (GLP-1 group) or metformin/acarbose (control group) for 3 months. Primary end-point: intra-abdominal fat content from baseline to 3 months; Secondary end-points: changes in fasting blood glucose, glycated haemoglobin (HbAlc), fasting insulin, blood lipids, weight, body mass index, and inflammatory cytokines from baseline to 3 months. Intra-abdominal fat content decreased in the GLP-1 group from baseline to 3 months (17,947 ± 5804; 13,717 ± 3628 mm2, P = 0.001, respectively), but was not significantly reduced in the control group (P = 0.197) and at 3 months post-treatment, it was significantly lower in the GLP-1 group than control group (P = 0.043). Glucose control, measured by HbA1c (GLP-1: 9.72 ± 1.38; 7.09 ± 0.60%, P < 0.001, 9.46 ± 1.25; 7.42 ± 0.84%, P < 0.001, respectively) and insulin resistance index LN(HOMA-IR) (GLP-1: 1.58 ± 0.40; 1.01 ± 0.33, P < 0.001, Control: 1.53 ± 0.57; 1.10 ± 0.33, P = 0.003, respectively) significantly improved in both groups with no significant difference between them. TNF-α, IL-6, and leptin were lower and adiponectin levels higher in the GLP-1 group at 3 months compared with baseline (all P < 0.05), but not significantly changed in the control group. TNF-α, IL-6 and leptin levels were similar between groups. Adiponectin level was higher in the GLP-1 group than the control group at 3 months (P = 0.025). Combined exenatide/metformin reduced intra-abdominal fat content, and enhanced insulin resistance and inflammatory status in patients with obesity and type-2 diabetes, representing a novel treatment regimen.