scholarly journals Cardiovascular events and all-cause mortality with insulin versus glucagon-like peptide-1 analogue in type 2 diabetes

Heart ◽  
2016 ◽  
Vol 102 (19) ◽  
pp. 1581-1587 ◽  
Author(s):  
Uchenna Anyanwagu ◽  
Jil Mamza ◽  
Rajnikant Mehta ◽  
Richard Donnelly ◽  
Iskandar Idris
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Events ◽  
All Cause Mortality ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

scholarly journals Glucagon-like Peptide-1 Receptor Agonists and Cardioprotective Benefit in Patients With Type 2 Diabetes Without Baseline Metformin: An Update Meta-analysis

2021 ◽  
Author(s):  
Augusto Lavalle Cobo ◽  
Walter Masson ◽  
Martin Lobo ◽  
Gerardo Masson ◽  
Graciela Molinero
Keyword(s):  
Type 2 Diabetes ◽  
Confidence Interval ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Receptor Agonists ◽  
All Cause Mortality ◽  
Secondary Endpoints ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Abstract Background: Sodium Glucose Co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) were associated with a reduction in cardiovascular events in cardiovascular outcomes trials (CVOTs) in type 2 diabetes. Most of the patients included in these trials received metformin as background therapy. The purpose of this study was to evaluate the effect of glucagon-like peptide-1 receptor agonists on major cardiovascular events (MACE) in metformin-naïve patients with type 2 diabetes.Methods: A meta-analysis was performed of randomized controlled clinical trials of GLP-1RAs on type 2 diabetes populations, after searching the PubMed/MEDLINE, Embase, Scielo, Google Scholar and Cochrane Controlled Trials databases. The primary endpoint was MACE. The secondary endpoints were cardiovascular death and all-cause mortality. A meta-analysis of time-to-event outcomes was performed.Results: Six eligible trials, including 10419 patients, were identified and considered eligible for the analyses. GLP-1RAs were associated with a significant reduction in MACE incidence (HR: 0.87, 95% confidence interval: 0.80–0.94; I2:0%). The analysis of the secondary endpoints showed a non-significant reduction in all-cause mortality (HR: 0.86, 95% confidence interval: 0.73-1.00 I2:0%) and cardiovascular mortality (HR: 0.81, 95% confidence interval: 0.63–1.05; I2:0%). Conclusions: In this meta-analysis, GLP-1RAs reduced the incidence of MACE in patients with type 2 diabetes without metformin at baseline, without significant reduction in all-cause mortality and cardiovascular mortality. These results support the fact that benefit in cardiovascular outcomes is independent of metformin use when GLP-1Ras are administered.

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.

scholarly journals Anti-diabetic Agents and the Potentials for Reducing Cardiovascular Risks in Type-2 Diabetes Mellitus

2021 ◽  
Vol 7 (3) ◽  
pp. 208-226
Author(s):  
IU Ezeani ◽  
A Eregie ◽  
AE Ohwovoriole
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cardiovascular Events ◽  
Mechanisms Of Action ◽  
Sglt2 Inhibitors ◽  
Major Adverse Cardiovascular Events ◽  
Cardiovascular Outcome Trials ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Recent reports from Cardiovascular Outcome Trials (CVOTs) revealed that some newer anti-diabetic drugs impact Major Adverse Cardiovascular Events (MACE). These medications include the Sodium-Glucose Co-Transporter (SGLT2) inhibitors and the Glucagon-like Peptide-1 (GLP-1) receptor agonists. There is a need for a review of the mechanisms of action of these drugs, in addition to their glucose-lowering effects and CV benefits. This review paper aims to explore the cardio-protective effects and CV risks of anti-diabetic medications, their mechanisms of action and the CV benefits evidenced by CVOTs. Using internet search, with search items such as Type 2 Diabetes mellitus, cardiovascular risk factors, cardiovascular outcome trials, major adverse cardiovascular events, sodium-glucose transporter-2 inhibitors, glucagon-like peptide-1 receptor agonist, the Google Scholar, EMBASE, PubMed, Medline, Web MD, and Scopus were checked for various relevant published articles. Analyses of the results of multiple CVOTs from various parts of the world were considered. These CVOTs were reviewed to assess the role of anti-diabetic agents in reducing cardiovascular risk in patients with T2DM. The SGLT2 inhibitors and GLP1 agonists were found to be beneficial in lowering MACE when compared with placebo. This is in addition to their anti-hyperglycaemic benefits. In conclusion, SGLT2 inhibitors and GLP-1 agonists confer dramatic beneficial CV risk reduction on patients with T2DM, as shown by the various CVOTs. This is in addition to their anti-hyperglycaemic effects. This remarkable benefit justifies the need by various guidelines to adopt them as second line agents to metformin in managing patients with T2DM.

scholarly journals Oral GLP-1 analogue: perspectives and impact on atherosclerosis in type 2 diabetic patients

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
José Francisco Kerr Saraiva ◽  
Denise Franco
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Events ◽  
Diabetes Management ◽  
Plasma Lipids ◽  
Diabetic Patients ◽  
High Morbidity ◽  
Risk Of Death ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

AbstractCardiovascular events related to atherosclerosis are responsible for high morbidity and mortality among patients with type 2 diabetes. Improvement in care, especially in early stages, is crucial. Oral semaglutide, a glucagon-like peptide 1 analogue, controls blood glucose and results in significant body weight loss in patients with type 2 diabetes. Beyond these well-known effects, an interesting aspect of this drug is its antiatherogenic activity, which should be further explored in clinical practice. This paper reviews the evidence related to oral semaglutide decreasing cardiovascular risk in patients with type 2 diabetes, focusing on the drug’s antiatherosclerotic properties. The glucagon-like peptide 1 analogue restores endothelial dysfunction, induces vasodilatation, and reduces plasma lipids. Oral semaglutide showed cardiovascular safety profile, with significant reduced risk of death from cardiovascular events. Based on current data, clinicians should consider oral semaglutide for type 2 diabetes management.

scholarly journals A Nephrologist Perspective on Obesity: From Kidney Injury to Clinical Management

2021 ◽  
Vol 8 ◽  
Author(s):  
Clara García-Carro ◽  
Ander Vergara ◽  
Sheila Bermejo ◽  
María A. Azancot ◽  
Joana Sellarés ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Kidney Injury ◽  
Glucose Lowering ◽  
New Frontier ◽  
All Cause Mortality ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Treatment Of Obesity ◽  
Angiotensin Blockade

Obesity is one of the epidemics of our era. Its prevalence is higher than 30% in the U.S. and it is estimated to increase by 50% in 2030. Obesity is associated with a higher risk of all-cause mortality and it is known to be a cause of chronic kidney disease (CKD). Typically, obesity-related glomerulopathy (ORG) is ascribed to renal hemodynamic changes that lead to hyperfiltration, albuminuria and, finally, impairment in glomerular filtration rate due to glomerulosclerosis. Though not only hemodynamics are responsible for ORG: adipokines could cause local effects on mesangial and tubular cells and podocytes promoting maladaptive responses to hyperfiltration. Furthermore, hypertension and type 2 diabetes mellitus, two conditions generally associated with obesity, are both amplifiers of obesity injury in the renal parenchyma, as well as complications of overweight. As in the native kidney, obesity is also related to worse outcomes in kidney transplantation. Despite its impact in CKD and cardiovascular morbility and mortality, therapeutic strategies to fight against obesity-related CKD were limited for decades to renin-angiotensin blockade and bariatric surgery for patients who accomplished very restrictive criteria. Last years, different drugs have been approved or are under study for the treatment of obesity. Glucagon-like peptide-1 receptor agonists are promising in obesity-related CKD since they have shown benefits in terms of losing weight in obese patients, as well as preventing the onset of macroalbuminuria and slowing the decline of eGFR in type 2 diabetes. These new families of glucose-lowering drugs are a new frontier to be crossed by nephrologists to stop obesity-related CKD progression.

scholarly journals SGLT2is vs. GLP1RAs Reduce Cardiovascular and All-Cause Mortality

2021 ◽  
Vol 8 ◽  
Author(s):  
Mei Qiu ◽  
Xu-Bin Wei ◽  
Wei Wei
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Indirect Evidence ◽  
Sodium Glucose Cotransporter ◽  
All Cause Mortality ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Lin et al. recently did a network meta-analysis based on cardiovascular (CV) outcome trials (CVOTs) of sodium-glucose cotransporter 2 inhibitors (SGLT2is) and those of glucagon-like peptide-1 receptor agonists (GLP1RAs). Due to the absence of CVOTs directly comparing SGLT2is with GLP1RAs, Lin et al.'s network meta-analysis identified the indirect evidence that SGLT2is vs. GLP1RAs reduced hospitalization for heart failure (HHF) but did not reduce CV death and all-cause mortality (ACM) in patients with type 2 diabetes (T2D). We did another meta-analysis incorporating those CV outcome cohort studies directly comparing SGLT2is with GLP1RAs, and identified that SGLT2is vs. GLP1RAs were significantly associated with the lower risks of not only HHF but also CV death and ACM. These findings may suggest that SGLT2is should be considered over GLP1RAs in terms of preventing CV and all-cause death and HHF in T2D patients.

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