scholarly journals Review of glucagon‐like peptide‐1 receptor agonists for the treatment of type 2 diabetes mellitus in patients with chronic kidney disease and their renal effects

2019 ◽  
Vol 11 (12) ◽  
pp. 938-948 ◽  
Author(s):  
Lance A. Sloan
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Type 2 Diabetes Mellitus ◽  
Kidney Disease ◽  
Renal Effects ◽  
Receptor Agonists ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

scholarly journals The effect of modern hypoglycemic therapy on the course of chronic kidney disease in patients with type 2 diabetes mellitus

2021 ◽  
Vol 17 (8) ◽  
pp. 624-632
Author(s):  
V.I. Katerenchuk
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Chronic Kidney Disease ◽  
Type 2 Diabetes Mellitus ◽  
Kidney Disease ◽  
Sodium Glucose Cotransporter ◽  
Combined Use ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

The article presents the literature review of the possibilities of modern antidiabetic therapy in the prevention of chronic kidney disease in patients with type 2 diabetes mellitus. The mechanisms of development and features of kidney disease in type 2 diabetes mellitus are described. The results of most recent clinical trials for studying the possibility of nephroprotection with new groups of hypoglycemic agents are reviewed: dipeptidyl peptidase-4 inhi-bitors, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors. The advantages of usage and the nephroprotective effects of agonists of glucagon-like peptide-1 receptors and sodium-glucose loop cotransporter-2 inhibitors are determined. Particular attention is paid to the nephroprotective effect of sodium-glucose loop co-transporter inhibitors as the only class of drugs that have demonstrated a reduction in the rate of decrease in glomerular filtration rate in patients with diabetes. The expediency of further study of the efficacy of the combined use of sodium-glucose cotransporter-2 inhibitors and agonists of glucagon-like peptide-1 receptors in diabetic chronic kidney disease is indicated. For a long time, approaches to the treatment of diabetic kidney disease did not differ for patients with type 1 and type 2 diabetes. The stu­dies of recent years have shown that new hypoglycemic drugs can not only lower blood glucose levels but also have a beneficial effect on renal function. The mechanisms of nephroprotective effects have not been fully studied, but it is clear that they are beyond the scope of improved glycemic control. The possibility of the nephroprotective effect of these drugs on a glomerular filtration rate in the range of 30–15 ml/min/1.73 m2 and below remains unexplored. The effect of the combined use of glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors is also unclear: will this combination predominate over monotherapy, and, if so, to what extent?

scholarly journals Effect of probiotics and incretine mimeticss on the levels of glucagon-like peptide-1 in blood serum of patients with type 2 diabetes mellitus

2021 ◽  
Vol 17 (8) ◽  
pp. 604-612
Author(s):  
K.A. Shyshkan-Shyshova ◽  
O.V. Zinych ◽  
N.M. Kushnareva ◽  
A.V. Кovalchuk ◽  
O.V. Prybyla
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Body Composition ◽  
Intestinal Microbiota ◽  
Receptor Agonists ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Group 2

Background. Type 2 diabetes mellitus is characterized by a violation of the incretin effect, in particular a decrease in the secretion of glucagon-like peptide-1 (GLP-1) by intestinal endothelial cells. In recent decades, the intestinal microbiota has been shown to play a key role in the regulation of various metabolic pathways, immune system activity, and intestinal permeability. It has been shown that the composition of bacterial genera in the intestine can unfluence the effectiveness of antidiabetic drugs (eg metformin and GLP-1 receptor agonists), which may be reduced in dysbiosis. Therefore, it is of interest to study the mechanisms that mediate the effect of microbiota on the incretin secretion. The purpose was to establish the relationship between the effects of probiotic therapy, incretin therapy and the level of endogenous GLP-1 in the serum of patients with type 2 diabetes mellitus, taking into account anthropometry and body composition. Materials and methods. We examined 23 patients with type 2 diabetes mellitus (11 women and 12 men), their average age was 56.4 ± 10.5 years (M ± SD). At the beginning of the study, the mean HbA1c level was 7.7 ± 1.5 %; all patients took metformin at an average dose of 1,500 mg/day. Patients were randomized into 2 groups: group 1 (n = 11) received a probiotic, group 2 (n = 12) — a long-acting GLP-1 receptor agonist. The concentration of GLP-1 in the blood serum was determined by the enzyme-linked immunosorbent assay, anthropometry parameters and body composition were assessed using the Tanita analyzer. Results. In the group of patients who took the probiotic, a significant increase in GLP-1 was observed, but less pronounced compared to an increase in GLP-1 level in the group of patients who took GLP-1 receptor agonists. In group 2, on the background of taking GLP-1 receptor agonists, a significant decrease in body weight, total and abdominal fat content, and a decrease in dehydration were revealed. Conclusions. An increase in the concentration of endogenous GLP-1 against the background of probiotic therapy indicates a possible positive effect of normalization of the intestinal microbiota on the secretion of endogenous incretins. The results obtained suggest that the use of a combination of probiotic and GLP-1 receptor agonists may have an additive effect on the hormonal and metabolic profile in patients with type 2 diabetes mellitus.

scholarly journals Effects of glucagon-like peptide-1 receptor agonists on major cardiovascular events in patients with Type 2 diabetes mellitus with or without established cardiovascular disease: a meta-analysis of randomized controlled trials

2020 ◽  
Vol 41 (35) ◽  
pp. 3346-3358 ◽  
Author(s):  
Fabio Marsico ◽  
Stefania Paolillo ◽  
Paola Gargiulo ◽  
Dario Bruzzese ◽  
Simona Dell’Aversana ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Receptor Agonists ◽  
Type 2 Dm ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Abstract Aims  Glucose-lowering, glucagon-like peptide-1 (GLP-1) receptor agonists reduce incidence of major cardiovascular (CV) events in patients with Type 2 diabetes mellitus (DM). However, randomized clinical trials reported inconsistent effects on myocardial infarction (MI) and stroke, and limited data in DM patients without established CV disease (CVD). Very recently, new relevant evidence was available from additional CV outcome trials (CVOTs) that also included large subgroups of patients with DM without established CVD. Thus, the aim of this meta-analysis was to investigate the effects of GLP-1 receptor agonists on major CV events and safety in DM patients with and without established CVD. Methods and results  In this trial-level meta-analysis, we analysed data from randomized placebo-controlled CVOTs assessing efficacy and safety of GLP-1 receptor agonists in adult patients with Type 2 DM. We searched PubMed, Embase, Cochrane, ISI Web of Science, SCOPUS, and clinicaltrial.gov databases for eligible trials. Of 360 articles identified and screened for eligibility, seven CVOTs were included, with an overall of 56 004 patients included. The difference in efficacy with respect to the major adverse cardiovascular events (MACE) primary endpoint (including CV mortality, non-fatal MI, and non-fatal stroke) between patients with established CVD and patients with CV risk factors only was not significant [pooled interaction effect, expressed as ratio of hazard ratio (HR) 1.06, 95% confidence interval (CI) 0.85–1.34]. In the analysis of the whole population of DM patients, GLP-1 receptor agonists showed a significant 12% reduction in the hazard of the three-point MACE composite endpoint (HR 0.88, 95% CI 0.80–0.96) and a significant reduction in the risk of CV mortality (HR 0.88, 95% CI 0.79–0.98), all-cause mortality (HR 0.89, 95% CI 0.81–0.97), fatal and non-fatal stroke (HR 0.84, 95% CI 0.76–0.94), and heart failure (HF) hospitalization (HR 0.92, 95% CI 0.86–0.97). No significant effect was observed for fatal and non-fatal MI (HR 0.91, 95% CI 0.82–1.02), although in a sensitivity analysis, based on a less conservative statistical approach, the pooled HR become statistically significant (HR 0.91, 95% CI 0.83–1.00; P = 0.039). No excess of hypoglycaemia, pancreatitis, and pancreatic cancer was observed between GLP-1 receptor agonists and placebo. Conclusion  Glucagon-like peptide-1 receptor agonists significantly reduce MACE, CV and total mortality stroke, and hospitalization for HF, with a trend for reduction of MI, in patients with Type 2 DM with and without established CVD.

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