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Add-on liraglutide treatment significantly reduced mean body weight 5. Add-on liraglutide treated patients had lower rate of hypoglycemic events and greater insulin and oral antidiabetic drugs discontinuation.

Gastrointestinal disorders were the most common adverse events in the liraglutide added treatment, but were transient.

Addition of liraglutide to abdominally obese, insulin-treated patients led to improvement in glycemic control similar to that achieved by increasing insulin dosage, but with a lower daily dose of insulin and fewer hypoglycemic events.

Adding liraglutide to insulin also induced a significant reduction in body weight and waist circumference. Liraglutide combined with insulin may be the best treatment option for poorly controlled type 2 diabetes and abdominal obesity.

The prevalence of obesity and diabetes has rapidly increased worldwide Western and Asian countries [ 1 , 2 ].

Obesity, especially visceral fat adiposity, also increases the risk of T2D, hypertension and atherosclerosis, suggesting that obese patients with T2D are at high risk for cardiovascular disease CVD [ 4 ].

In addition, Chinese have more risk factors for CVD because they have relatively more visceral fat at the same body mass index BMI than Europeans do [ 5 ].

Obese patients with T2D ultimately require insulin therapy to achieve glycemic control over time. However, insulin treatment is commonly associated with hypoglycemia and weight gain.

This then leads to further increases in insulin requirement and weight gain. In this sense, it is necessary to develop effective and efficient therapeutic strategy for T2D and abdominal obesity as well as decreasing cardiovascular risk.

Glucagon-like peptide-1 GLP-1 receptor agonists are the newest class of T2D therapy currently available, which improve hyperglycemia through increasing insulin secretion and reducing glucagon secretion [ 7 , 8 ], slowing gastric emptying, delaying carbohydrate absorption, and increasing satiety, leading to reduced caloric intake [ 9 ].

In Liraglutide Effect and Action in Diabetes LEAD 1—6 trials, substantial and sustained improvement in HbA1c, fasting plasma glucose and postprandial glucose have been observed with liraglutide treatment [ 10 — 15 ].

Several studies have shown that liraglutide treatment results in greater reduction in fat mass than in the lean body mass. Furthermore, visceral fat mass decreases more than abdominal subcutaneous fat mass [ 11 , 12 , 16 ].

Therefore liraglutide might be a promising new agent for the treatment of T2D and abdominal obesity linked to high risk of CVD.

The combination of exenatide with insulin has been shown to have an insulin-sparing effect in insulin-treated patients with T2D as well as a weight loss benefit in several small uncontrolled studies, furthermore, these studies reported a low incidence of severe hypoglycemia [ 17 ].

However, only one small retrospective study had shown that adding liraglutide to insulin therapy resulted in a significant improvement in glycemic control, reduction in insulin requirement, and reduction of body weight without significant hypoglycemia [ 18 ].

Therefore, the present study compared the efficacy and safety of adding liraglutide versus increasing insulin dose strategy in insulin-treated poorly controlled T2D and abdominal obesity.

This study was undertaken in the out-patient setting of the Metabolic Disease Hospital of Tianjin Medical University between October and May Patients eligible for the study met the following criteria: diagnosis of T2D defined by America Diabetes Association in ; HbA1c 7.

Patients who were taking medications, aside from antidiabetic medications, known to affect glycemic or weight control, such as glucocorticoids or orlistat, were also excluded.

This was a parallel-group, open-label, randomized clinical trial over a week observation period. All patients provided written informed consent and confirmed their willingness to perform glucose self-monitoring.

This study design was approved by the local ethics committee review board and was conducted using Good Clinical Practice in accordance with the Declaration of Helsinki.

The eligible patients were randomized to either the liraglutide-added group or the insulin-increasing group on the basis of computer-generated random numbers, by a person not involved in recruitment of patients.

In the liraglutide-added group, liraglutide was initiated at a dose of 0. In the insulin-increasing group, insulin doses were increased to reach the glycemic targets.

During the study, patients continued their usual diet and exercise regimens as well as any concomitant glucose-lowering medications. The dialectologists can first decide to discontinue oral insulin secretagogues in the events of hypoglycemia or hypoglycemic symptoms occurred in the daytime; if hypoglycemia occurred in the nighttime, the investigators can consider decreasing insulin dose or discontinuing insulin treatment according to their clinical judgements.

So this study treatment reflects the real-world practice. Patients were seen in follow up at baseline, 2, 4, 8 and 12 weeks. Clinical parameters evaluated at baseline and at 3 months included HbA1c, total daily insulin dose, total-triglyceride TG , total-cholesterol, LDL-cholesterol and HDL-cholesterol.

Body weight, waist circumference, FBG and P2BG were measured at every clinic visit baseline, at 2, 4, 8 and 12 weeks.

Hypoglycemic episodes and adverse events AEs were recorded throughout the study. All patients were taught how to recognize the signs and symptoms of hypoglycemia and instructed to obtain a blood glucose reading whenever symptoms of hypoglycemia occurred.

Hypoglycemia was determined by the number of plasma glucose readings that were below 3. Hypoglycemia was considered severe when the event required third party assistance.

Adverse events were classified as serious if they resulted in death, life-threatening experiences, hospitalization, or persistent of significant disability or incapacity.

Changes in parameters from the baseline values within group were evaluated using 2-tailed paired t -test. Unpaired t test was used to compare the differences in clinical characteristics between groups at baseline and after treatment assessed for significance using for the discrete or continuous data and the chi-square test for frequency distributions.

A total of 90 patients entered the trial and 84 patients Three patients dropped out the study two changed hospital, one was lost of follow up , three patients were excluded as a result of protocol violation.

Of these, 42 patients were randomly assigned to receive liraglutide to current insulin therapy Liraglutide-added group and 42 patients were assigned to increase the current insulin dose Insulin-increasing group.

My growth spurt was pretty big which caused some problems. When you walk around at the height of 5'10 in sixth grade and then by the end of middle school you're 6'1 it can cause you some self esteem issues.

Weapon77 Xper 5. My acne was horrible. There was little I could do and it killed my confidence which still has not completely bounced back.

Everything else was fine. Now that I think about it, the mood swings were pretty bad too, but the acne was worse. Eh, puberty for me wasn't a big deal.

I was well prepared for periods way before I actually got it, I didn't get really bad mood swings and everything else was relatively minor.

Acne is the worst though, still dealing with it. MaddyMax Xper 5. Around the time I was 12 or 13 my body changed entirely.

I got a curvy figure immediately and since then I've been 5' Around that time I was taller than about everyone and in 8th grade was when some of the boys caught up with me in height.

For my body I was ignorant at the time how boys can act and I learned my lesson for doing something dumb. VaIiant Yoda.

I personally loved puberty. When people see photos of me in, say, 2nd grade, jokes are made. My waist got a lot smaller, I got taller, my facial features changed a lot.

I really, really hate my period though. Show All Show Less. SpiderBro Xper 5. I bet people r gonna say acne.

But I never had acne tbh. The only thing I hate about my pubety was my period. Other than that, everything else was fine.

The insecurity, the pimples, the fear of being the outcast. UltimateGohan Yoda. Acne and Erections :D Random boners which were impossible to conceal.

Hating this type of shit. Acne only hit in grade 10, I remember my friend got a pimple in grade 8 and I was like "bro wtf is that?

Wildflower8 Xper 5. Lol, for me it's acne! Please go check out my question. Acne and the early development of secondary sex characteristics.

I have had 34B-C's in 5th grade along with wide af hips. That's the perfect "event" for strechmarks to develop lots of it.

Acne and the fact that my body was starting to produce more sweat and oil. It really grossed me out.

The mood swings. It was hell for my parents and hell for me and hell for anybody else around. Milli95 Xper 4. Pimples hair fall mood swings unwanted hair growth, later I came to know that it was all because of pcod, it was terrible I am still trying to deal with it.

Jus Xper 2. The constant boners. I'm in science class fell asleep bam! I'm in gym shretching bam! Boner Minding my own business doing something normal nope bam!

It's a hard for me to decide because menstruation and "those" feelings really made my puberty really hard to get through.

I'm pretty sure you are white, or I don't know what white means anymore. Under the White Australia policy, you'd have been as white as a Czech though less than a German.

Simply put, because struggles and hardships do not care what colour we are and people should be assessed as individuals.

The idea behind white privilege is that white people have intrinsic, unearned advantages over non-whites that should be combated.

The same theory is extended to gender; to be male is to have unearned advantage beyond biological difference. This is the theory.

The issue is, when you look at the facts, things start to fall apart; for example, white, working class boys are the group that does the worst in the GCSEs in the UK.

If white males really have unearned advantages in society, why are they performing so poorly -- in fact, the worst out of all groups?

Does a white homeless man sleeping on a park bench think to himself, "Any day now, my white male privilege will get me out of this one, no worries"?

Privilege isn't a monolithic status you apply to people without nuance. Sure, that hypothetical white homeless person might not seem very privileged compared to your average Redditor, but put him next to an Aboriginal homeless person, and I suspect people's perspectives would change somewhat.

If that's so, what's the justification for white, working class boys being the worst-performing group in the GCSEs bearing in mind the huge impact education has on quality of life while also being privileged?

The grim reality is that Aboriginal homeless person has access to every single service that the white homeless person has access to, but the reverse is not true because there are specific services available to Aboriginal homeless people that are explicitly and expressly not available to whites.

So simply, objectively, that white person is actually at a disadvantage to the Aboriginal person. This is the problem with discussions about privilege.

I'm sure your answer to the above is "well that is true, but privilege is more nuanced than that". So it can't be disproven.

There is no way to argue that "white people are not privileged" because it's a conclusion looking for evidence, not evidence looking for a conclusion.

For example, many would assert that being male brings with it privilege in today's society over being female. An acute example of this is job applications; studies have been done which show that when you submit identical resumes with the names swapped, people pick the male name.

Therefore, this is male privilege; you are more likely to succeed with identical qualifications if you are male.

An unearned advantage. A clear example of privilege and the perks of being male in our society. Except the exact opposite is true. When you strip out the names from resumes completely, men's resumes were significantly more likely to be picked than women's resumes, even though there was no way to tell who was male or female.

Now, suddenly, the boot's on the other foot. This isn't a clear example of privilege anymore; no, no, no.

Now this is just an outlier, an aberration. Men are still privileged. That's just the fact. This study doesn't disprove anything.

Again, this is the problem. Its an assertion that cannot be disproved, and any assertion that can't be disproved is worthless. The result in that article is completely in line with the modern understanding of gender inequality.

The faulty underlying assumption you have is that a resume is an objective representation of a persons ability and experience. On average men overestimate their ability compared to women.

On average men are more likely to attribute attribute failure to external factors, and success to their own ability.

There are many differences which society instills in people at a very young age. A resume is , as best as we can determine, an objective representation of a person's ability.

It says: "I got these qualifications, I worked at X for Y period, this is why you should hire me. Or the men's fault for overstating their ability.

Or perhaps both need to meet in the middle somewhere. That's kinda the entire point of a resume - to try and sell yourself, emphasise your strengths, downplay your weaknesses, and talk up your capabilities.

If you can't do that, well frankly you don't deserve the job. What you said is almost like complaining that it's the man's fault that a women didn't get the job because the man does too good of a job.

It's not up to the man to downplay his capabilities and fall on the sword of social justice, it's up to the woman to step up and convince people that she's just as capable.

It would be a better system if people didn't misrepresent themselves. That is how we end up with people getting misleveled and underperforming.

It's also what leads to bad managers and the kinds of issues everyone bemoans. The job shouldnt go tothe best self-promoter. The fact that it works that way is a problem we should be trying to solve.

Your problem is that youre using the term privilege to refer to individuals when its a term used to describe a population. Sure those two hypothetical homeless people, the aboriginal one has access to more.

Thats a singular situation that you created to justify your narrative. When you look at the whole population you see that aboriginal people are far more likely to be homeless overall so they are, AS A GROUP, less privileged.

Hence the extra services to attempt to address this injustice. White people as an entire group have privilege.

Pulling individuals out of the population to argue against privilege is like saying "its cold today, so much for global warming". Stupid and missing the entire point.

Let me be clear about this: I have no problem with speaking in generalistions about collectives. My problem is when people argue from the general to the specific.

A good example: The question is asked, "do black people commit more violent crime than white people? However, is it therefore fair to argue that "since black people commit more violent crime than white people, the black guy in accounting is violent"?

If one person has objectively more access to resources than the other, how is the OTHER person privileged? By that metric, if I quit my job and sit home all day shitposting on Reddit for a living, can I call my former workmates privileged because they still work, and still have income, and still have money and all the perks it brings?

Because even though we had the same opportunities, I made different choices that sucked for me in the long term? That's seemingly what you're arguing.

But not individual white people, so if you're going to examine the individual anyway, why bother with the collective?

Why bother saying "white people have privilege" if not all, not even most, white people are privileged?

Are you sure it's not the other way around -- more like looking at a tiger cage in a zoo and saying "Using this cage as a sample size, the average tiger population of Earth is two tigers per fifty square metres"?

Overly specific sampling as you illustrated earlier cuts both ways. How do we know you're not the one saying "some white people are privileged, so much for equality"?

Just because a single person in the group isn't privileged, doesn't mean the others aren't. Think of it as a set of data. There's a set for white people ans a set for aboriginals.

Almost anything you plot becomes a bell curve. The white people bell curve it just shifted a bit higher. So you'll still have white people who are having a shit time, and you'll still have aboriginals whore having a great time.

But overall you see that white people are having a better time than aboriginals. Taking two points from the data doesn't prove or disprove that.

Its not a concept that should be applied at an individual level. Because sociological articles will justify their sample size.

This doesnt just come from some special snowflake deciding white people suck. Its been studied for near on 50 years. Anything that applies to "white people" must, by definition, apply to all white people.

It's axiomatic. Like saying, "white people have white skin". Are there white people who have African skin tones? There are none. Because those are not, by definition, white people.

I absolutely don't deny this and, as someone who grew up in the NT and lived there for 25 years, the discrepancy between white people and Indigenous people is vast.

However, what I don't accept is that this difference is due to special, subtle, unearned advantages that are almost impossible to quantify yet produce such vastly different results.

Small differences in how people are treated by society at large cannot, realistically, such large differences in outcome make.

As I said. I have no problems talking about group trends because trends among groups can be observed and should be.

And yes, there is a pretty big gulf between white people and Indigenous persons by basically any metric these days.

However, in my experience, 'privilege' is almost always applied at an individual level rather than a group level.

Applying it by race does exactly this. The difference in privilege between two homeless people by their race is completely meaningless.

With that case, you also see a geographical divide in results as well, suggesting poorer access to resources.

This article explains how cultural differences and the fact ethnic minorities are more likely to live in areas with better educational facilities like London, could explain the reason for poor white males to be doing the worst in the GCSEs.

But even then, we see an example of privilege. This report from the UK government found "Poor white boys do worse in schools but black and Asian Muslim young people, girls especially, do worse for jobs," and are "less likely to face social immobility".

You act like there are only two sets of privilege, but class privilege is a very real thing which you've ignored in your rush to dismiss privilege as a concept.

Also, in this comment you use a study about blind recruitment. However, you try to extend the results of a study done on public service to all careers, despite the authors of the article never intending for it to be read in that way.

Furthermore, the study focused on senior positions which considering a majority of senior public servants are male and thus more likely to have relevant experience , and was only in the context of being shortlisted for an interview and not the actual employment.

I mean, if we're just pointing out random studies, what do you think about blind auditions making it more likely for women to get into orchestras?

You're simplifying the discussion when there's a wide range of sociological factors in play. The most educated people per-capita in the United States are not whites.

They are Jews, Indians, and other ethnicity. Do they have privilege? Or is it only whites? If you look at the richest ethnicity, the most educated ethnicity, the ethnicity in jobs like finance, marketing, sales, stocks, self-employed, etc, the leading results are whites only by absolute numbers.

Not per-capita. Because maybe things are different and different fields have different kinds of biases and different kinds of sociological factors affect things in complex, nuanced ways we don't really understand because they are so complex, so hitting society with a hammer and saying "White males ALWAYS have unearned advantage over all other people, period!

Working class is a bit misleading, in fact white males are not the worst performing group It's actually female Black Caribbeans. Those statistics only use eligibility for free school meals FSE , gender, and ethnicity.

The study uses data that compares the level of attainment for disadvantaged eligible for FSE and non-disadvantaged.

Essentially the attainment gap is largest for Irish and white British teenagers whilst it has decreased dramatically over the past decade for other groups.

Just because they are performing poorly doesn't mean they aren't privileged in some way. The much smaller minorities tend to have stronger family aspirations and positive cultural attitudes to learning.

The idea behind white privilege is that in 'white countries', due to history, people may stigmatise 'non-whites'. Also non-whites collectively may be in worse economic conditions as a result of past unfair treatment.

The summation of the effects of the aforementioned is white privilege. What you are doing with the homeless white man example is trying akin to using macroeconomic analysis to explain microeconomics.

Would this count as an "unearned" advantage, aka privilege, or is that "earned"? By that logic, is not white people's general focus on education and school attendance an "earned" advantage?

What separates white people's advantages from theirs? And at some universities people stigmatise whites, including whole days where white people are not permitted to attend.

For example, Obama's daughters are, objectively, infinitely more privileged than almost any white person on the planet, save a small handful of people.

They have Secret Service protection for life so will never, ever be the victim of violent crime even if they instigate it for some reason and will never, ever fear for their personal safety.

We acknowledge the assistance of investigators and all subjects for participants in this study. This work was supported by the National Nature Science Foundation of China No.

National Center for Biotechnology Information , U. National Library of Medicine Rockville Pike , Bethesda MD , USA. NCBI Skip to main content Skip to navigation Resources How To About NCBI Accesskeys My NCBI Sign in to NCBI Sign Out.

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Journal List Cardiovasc Diabetol v. Cardiovasc Diabetol. Published online Nov PMCID: PMC Chun-jun Li , 1 Jing Li , 1 Qiu-mei Zhang , 1 Lin Lv , 1 Rui Chen , 1 Chun-feng Lv , 1 Pei Yu , 1 and De-min Yu 1.

Author information Article notes Copyright and License information Disclaimer. Corresponding author. Chun-jun Li: moc.

Received Sep 5; Accepted Oct This article has been cited by other articles in PMC. Abstract Objective To assess the efficacy and safety of adding liraglutide to established insulin therapy in poorly controlled Chinese subjects with type 2 diabetes and abdominal obesity compared with increasing insulin dose.

Methods A week, randomized, parallel-group study was carried out. Results At the end of study, the mean reduction in HbA 1c between the liraglutide-added group and the insulin-increasing group was not significantly different 1.

Conclusions Addition of liraglutide to abdominally obese, insulin-treated patients led to improvement in glycemic control similar to that achieved by increasing insulin dosage, but with a lower daily dose of insulin and fewer hypoglycemic events.

Keywords: Liraglutide, Abdominal obesity, Insulin therapy, Weight reduction. Introduction The prevalence of obesity and diabetes has rapidly increased worldwide Western and Asian countries [ 1 , 2 ].

Materials and methods Subjects This study was undertaken in the out-patient setting of the Metabolic Disease Hospital of Tianjin Medical University between October and May Study design This was a parallel-group, open-label, randomized clinical trial over a week observation period.

Clinical measurements Clinical parameters evaluated at baseline and at 3 months included HbA1c, total daily insulin dose, total-triglyceride TG , total-cholesterol, LDL-cholesterol and HDL-cholesterol.

Results Baseline clinical characteristics A total of 90 patients entered the trial and 84 patients Table 1 Characteristics of the patients at baseline.

Open in a separate window. Glycemic control and reduction of diabetes treatment Over the week treatment period, mean values of HbA 1c , FBG and P2BG were significantly reduced in both treatment groups.

Table 2 Changes of variables related with glucose metabolism after 12 weeks. Body weight and waist circumference Body weight, waist circumference and BMI were significantly decreased from baseline to 12 weeks in the liraglutide-added group, the mean reductions in body weight, waist circumference and BMI were 5.

Figure 1. Figure 2. Hypoglycemia No severe hypoglycemia was reported in the liraglutide-added group, while two patients in the insulin-increasing group reported severe hypoglycemia.

Adverse events The incidence of adverse events was higher in the liraglutide-added group than in the insulin-increasing group Discussion Compared with increasing the insulin dose therapy, the present study demonstrated the beneficial effects of adding the long-acting GLP-1 analog liraglutide to established insulin therapy, which resulted in a significant improvement in glycemic control, reduction in insulin requirement, lower incidence of hypoglycemia events and weight loss in the Chinese patients with poorly controlled T2D and abdominal obesity.

Conclusions In conclusion, adding liraglutide to insulin therapy provides a better chance of achieving good glycemic control with a lower daily insulin dose and fewer hypoglycemic events compared to increasing insulin dose.

Abbreviations AEs: Adverse events; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BMI: Body mass index; CVD: Cardiovascular disease; FBG: Fasting blood glucose; GLP Glucagon-like peptide-1; HbA1c: Glycosylated hemoglobin; LEAD: Liraglutide Effect and Action in Diabetes; OAD: Oral antidiabetic drugs; P2BG: 2 hour postprandial blood glucose; T2D: Type 2 diabetes.

Competing interests The authors declare that they have no conflicts of interest. Acknowledgements We acknowledge the assistance of investigators and all subjects for participants in this study.

References Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the developing world-a growing challenge. N Engl J Med. Diabetes in Asia: epidemiology, risk factors, and pathophysiology.

Liraglutide provides similar glycaemic control as glimepiride both in combination with metformin and reduces body weight and systolic blood pressure in Asian population with type 2 diabetes from China, South Korea and India: a week, randomized, double-blind, active control trial.

Diabetes Obes Metab. Adiponectin and metabolic syndrome. Arterioscler Thromb Vasc Biol. Visceral adipose tissue accumulation differs according to ethnic background: results of the Multicultural Community Health Assessment Trial M-CHAT Am J Clin Nutr.

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1 Kommentar

  1. Tolkree

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