Abstract
BackgroundGlucagon-like peptide-1 (GLP-1) receptor agonists can maintain good glycemic control in some diabetic. Here we compared the clinical characteristics and parameters reflecting glucose metabolism at the time of the initiation of GLP-1 receptor agonist therapy between patients who responded well to therapy and those who did not.MethodsThe records of 43 patients with type 2 diabetes who started receiving GLP-1 receptor agonist therapy during hospitalization were retrospectively reviewed. Glucagon stimulation tests were performed, and patients were started on liraglutide or exenatide therapy. Preprandial blood glucose levels were measured on days 2 and 3 of GLP-1 receptor agonist therapy. We used the Cox proportional hazard model to compare clinical parameters between responders (HbA1c level <8% at more than 3 months after the initiation of treatment) and non-responders (HbA1c level ≥8% at more than 3 months after the initiation of treatment or a switch to insulin therapy at any time).ResultsTwenty-six of the 43 patients were classified as non-responders. At baseline, mean HbA1c levels were 9.9% among responders and 9.7% among non-responders. Compared with treatment with only diet or metformin, the hazard ratio [HR] for non-response was 5.3 (95% confidence interval [CI]: 1.16-24.6, P = 0.03) for insulin therapy and 5.0 (95% CI: 1.13-22.16, P = 0.03) for sulfonylurea therapy. Compared with the lowest tertile, the HRs for non-response in the highest tertile were 3.1 (95% CI: 1.04-8.97, P = 0.04) for the mean preprandial blood glucose level on days 2 and 3 and 3.4 (95% CI: 1.05-11.01, P = 0.04) for the body mass index. The response was not significantly associated with the duration of diabetes or the glucagon stimulation test results. A receiver operating curve analysis showed that the mean preprandial blood glucose level had the highest area under the curve value (=0.72) for the prediction of non-responders.ConclusionsIn patients with poorly controlled diabetes, the response to GLP-1 receptor agonist therapy was significantly associated with the treatment used before the initiation of therapy, the body mass index, and the mean preprandial blood glucose level during the 2 days after the initiation of therapy.
Highlights
Glucagon-like peptide-1 (GLP-1) receptor agonists can maintain good glycemic control in some diabetic
GLP-1 receptor agonist therapy was initiated after a glucagon stimulation test, starting with liraglutide (0.3 mg daily) or exenatide (5 μg twice daily)
Twenty-six patients were classified as non-responders, of which three discontinued GLP-1 receptor agonist therapy within 3 months because of high blood glucose levels
Summary
Glucagon-like peptide-1 (GLP-1) receptor agonists can maintain good glycemic control in some diabetic. Association (AHA), glucagon-like peptide-1 (GLP-1) receptor agonists, such as liraglutide and exenatide, are recommended because of their ability to maintain good glycemic control in diabetic patients without resulting in weight gain or significant hypoglycemia [1,2]. They have been shown to help maintain β-cell mass and function [3]. In consideration of low risk of hypoglycemia and lesser effect on body weight gain, previous studies [7,8,9] have been switched from insulin therapy to GLP-1 receptor agonist therapy and certain number of the patients have been regarded effective
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