Clinical Trials Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Nov 15, 2020; 11(11): 514-526
Published online Nov 15, 2020. doi: 10.4239/wjd.v11.i11.514
Factors associated with improvement in waist-to-height ratio among newly diagnosed type 2 diabetes patients treated with acarbose or metformin: A randomized clinical trial study
Lu-Lu Song, Xin Wang, Zhao-Jun Yang, Xiao-Mu Kong, Xiao-Ping Chen, Bo Zhang, Wen-Ying Yang
Lu-Lu Song, Xin Wang, Zhao-Jun Yang, Xiao-Mu Kong, Xiao-Ping Chen, Bo Zhang, Wen-Ying Yang, Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, China
Author contributions: Yang WY was the principal investigator of the trial; Song LL drafted the manuscript; Wang X was the co-investigator; Yang ZJ developed design of the trial; Kong XM provided important advice and guidance regarding the statistical analysis; and Chen XP and Zhang B contributed to the trial.
Institutional review board statement: The study was reviewed and approved by the China-Japan Friendship Hospital Institutional Review Board
Clinical trial registration statement: This study is registered at Chinese Clinical Trial Registry Center. The registration number is ChiCTR-TRC-08000231.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors have nothing to disclose.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wen-Ying Yang, MD, Professor, Department of Endocrinology, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing 100029, China. yangwenying@zryhyy.com.cn
Received: June 28, 2020
Peer-review started: June 28, 2020
First decision: July 30, 2020
Revised: August 13, 2020
Accepted: September 14, 2020
Article in press: September 14, 2020
Published online: November 15, 2020
Abstract
BACKGROUND

The waist-to-height ratio (WHtR) is a promising anthropometric measure used to evaluate cardiovascular risk in diabetes and metabolic syndrome patients. The metformin and acarbose in Chinese as the initial hypoglycaemic treatment trial demonstrated that acarbose and metformin reduced the WHtR after 24 wk of treatment.

AIM

To investigate the factors associated with a decrease in the WHtR in newly diagnosed Chinese type 2 diabetes patients receiving acarbose or metformin monotherapy.

METHODS

At 24 wk, 343 patients in the acarbose treatment and 333 patients in the metformin treatment were included in this analysis. On the basis of the reduction in the WHtR, these participants were divided into the following two groups: Low ΔWHtR group and high ΔWHtR group. Metabolic and related parameters associated with a high ΔWHtR were investigated using univariate and multivariate logistic regression analyses.

RESULTS

A significant decrease in the WHtR was observed in both treatment groups (acarbose: -0.015, 95% confidence interval [CI]: -0.018 to -0.012, P < 0.001; metformin: -0.013, 95%CI: -0.016 to -0.010, P < 0.001). In both the acarbose and metformin groups, the WHtR of the women was more likely to be reduced than that of the men. In the acarbose group, a lower baseline area under the curve of glucagon-like peptide 1 (AUCGLP-1) was associated with a high ΔWHtR (odds ratio [OR] = 0.796, P < 0.001), while a higher baseline AUCGLP-1 was associated with a high ΔWHtR in the patients treated with metformin (OR = 1.133, P = 0.025). Regarding the changes from baseline, an increase in AUCGLP-1 was associated with a high ΔWHtR in the acarbose (OR = 1.121, P = 0.016) but not metformin group. A higher reduction in high-density lipoprotein cholesterol/non-high-density lipoprotein cholesterol was also associated with a high ΔWHtR in the acarbose arm (OR = 20.735, P = 0.001). In the metformin arm, a higher reduction in fasting plasma glucose (OR = 0.843, P = 0.039) and total cholesterol was associated with a high ΔWHtR (OR = 0.743, P = 0.013).

CONCLUSION

A lower glucagon-like peptide 1 level and higher increase in glucagon-like peptide 1 are associated with a high reduction in the WHtR in newly diagnosed Chinese diabetes patients receiving treatment with acarbose.

Keywords: Waist-to-height ratio, Abdominal obesity, Type 2 diabetes, Association, Acarbose, Metformin

Core Tip: Obesity, especially abdominal obesity is an important risk factor for cardiovascular diseases in type 2 diabetes. The metformin and acarbose in Chinese as the initial hypoglycaemic treatment trial demonstrated that acarbose and metformin not only reduced glycosylated hemoglobin but also reduced weight and waist circumference after 24 wk of treatment with acarbose or metformin. Waist-to-height ratio waist-to-height ratio is a new anthropometric measure as an indicator of abdominal obesity and a better alternative to waist circumference. In this analysis, we demonstrated different association of glucagon-like peptide 1 and some other parameters with reduction of waist-to-height ratio in acarbose or metformin treated patients.