Abstract
Rationale It is well known that diabetes mellitus (DM) exacerbates the mechanisms underlying atherosclerosis. Currently, glucagon-like peptide-1 receptor agonists (aGLP-1) have one of the most prominent cardioprotective effects among the antidiabetic agents. However, the treatment with aGLP-1 is effective only in 50-70% of the cases. Taking into account the high cost of these medications, discovery of the predictors of optimal response to treatment is required. Purpose To identify the predictors of the greater impact of aGLP-1 on HbA1c levels, weight reduction, and improvement in lipid profile. Methods The study group consisted of 40 patients with type 2 DM (T2DM) and obesity who were treated with aGLP-1. The follow-up period was 24 weeks. Patients' evaluation was conducted at baseline and after 24 weeks. In addition, it included the assessment of the hormones involved in glucose and lipid metabolism and appetite regulation. Results Patients who have initially higher BMI (body mass index), glycemia, and triglycerides (TG) had better improvement in these parameters undergoing aGLP-1 treatment. In patients with a BMI loss ≥ 5%, GLP-1 and fasting ghrelin levels were higher and ghrelin level in postnutritional status was lower. The HbA1c levels decreased more intensively in participants with higher GLP-1 levels. TG responders had lower baseline fasting glucose-dependent insulinotropic peptide (GIP) and postprandial ghrelin levels. Conclusion The evaluation of the glycemic control, lipid profile, and GLP-1, GIP, and ghrelin levels are useable for estimating the expected efficacy of aGLP-1.
Highlights
It is well known that the rates of mortality due to cardiovascular and cerebrovascular diseases are markedly higher among people with type 2 diabetes mellitus (T2DM) [1]
What Has Changed after Treatment with Glucagon-like peptide-1 receptor agonists (aGLP-1)? Table 5 shows the clinical characteristics at baseline and after 24 weeks of treatment with aGLP-1
We found that the incretin level (GLP-1 initial level) predicts the glucose-lowering response on aGLP-1 therapy, the ghrelin level 2 hours after breakfast in the meal tolerance test predicts body weight reduction, and lower glucose-dependent insulinotropic polypeptide (GIP) and ghrelin after test levels predict TG level reduction
Summary
It is well known that the rates of mortality due to cardiovascular and cerebrovascular diseases are markedly higher among people with type 2 diabetes mellitus (T2DM) [1]. GLP-1 has a number of functions: augmenting insulin’s response to glucose, slowing gastric emptying, and suppressing the secretion of glucagon. The latter activates the secretion of hepatic glucose and increases satiety. AGLP-1 demonstrate an ability to improve the prognosis for cardiovascular diseases by means of a decrease of atherosclerotic events [3]. They improve the prognosis in diabetic patients with myocardial infarction [4, 5] and may reduce arrhythmic burden and hospital admissions for heart failure worsening in diabetic patients [6]
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