scholarly journals Effect of the Glucagon-like Peptide-1 Receptor (GLP-1R) Agonists on Autonomic Function in Subjects With Diabetes: a Systematic Review and Meta-analysis.

2021 ◽  
Author(s):  
Carla Greco ◽  
Daniele Santi ◽  
Giulia Brigante ◽  
Chiara Pacchioni ◽  
Manuela Simoni
Keyword(s):  
Heart Rate ◽  
Chronic Treatment ◽  
Autonomic Function ◽  
Meta Analysis ◽  
Low Frequency ◽  
Cochrane Collaboration ◽  
Metabolic Effects ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Autonomic Reflex

Abstract Background. In addition to the metabolic effects in diabetes, glucagon-like peptide 1 receptor (GLP-1R) agonists lead to a small but substantial increase in heart rate (HR). However, the GLP-1R actions on the autonomic nervous system (ANS) in people with diabetes remain still debated. Therefore, this meta-analysis evaluates the effect of GLP-1R agonist chronic treatment on measures of ANS function in people with diabetes. Methods. According to the Cochrane Collaboration and PRISMA statement, we conducted a meta-analysis considering clinical trials in which the autonomic function was evaluated in people with diabetes chronically treated with GLP-1R agonists. The outcomes were the change of ANS function measured by heart rate variability (HRV) and cardiac autonomic reflex tests (CARTs). Results. In the studies enrolled, HR significantly increased after treatment (p<0.001), whereas low frequency/high frequency ratio did not differ (p=0.410); no changes in other measures of HRV were detected. Considering CARTs, only the 30:15 value derived from lying-to-standing test was significantly lower after treatment (p=0.002), but only two studies reported this measurement. No differences in other CARTs outcome were observed. Conclusion. The present meta-analysis confirms the HR increase but seems to exclude an alteration of the sympatho-vagal balance due to chronic treatment with GLP-1R agonists in diabetes, considering the available measures of ANS function.

Cardiovascular and metabolic effects of 48-h glucagon-like peptide-1 infusion in compensated chronic patients with heart failure

2010 ◽  
Vol 298 (3) ◽  
pp. H1096-H1102 ◽  
Author(s):  
Mads Halbirk ◽  
Helene Nørrelund ◽  
Niels Møller ◽  
Jens Juul Holst ◽  
Ole Schmitz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Heart Rate ◽  
Diastolic Blood Pressure ◽  
Cardiovascular Effects ◽  
Tissue Doppler ◽  
Metabolic Effects ◽  
Left Ventricular Ejection ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

The incretin hormone glucagon-like peptide-1 (GLP-1) and its analogs are currently emerging as antidiabetic medications. GLP-1 improves left ventricular ejection fraction (LVEF) in dogs with heart failure (HF) and in patients with acute myocardial infarction. We studied metabolic and cardiovascular effects of 48-h GLP-1 infusions in patients with congestive HF. In a randomized, double-blind crossover design, 20 patients without diabetes and with HF with ischemic heart disease, EF of 30 ± 2%, New York Heart Association II and III ( n = 14 and 6) received 48-h GLP-1 (0.7 pmol·kg−1·min−1) and placebo infusion. At 0 and 48 h, LVEF, diastolic function, tissue Doppler regional myocardial function, exercise testing, noninvasive cardiac output, and brain natriuretic peptide (BNP) were measured. Blood pressure, heart rate, and metabolic parameters were recorded. Fifteen patients completed the protocol. GLP-1 increased insulin (90 ± 17 pmol/l vs. 69 ± 12 pmol/l; P = 0.025) and lowered glucose levels (5.2 ± 0.1 mmol/l vs. 5.6 ± 0.1 mmol/l; P < 0.01). Heart rate (67 ± 2 beats/min vs. 65 ± 2 beats/min; P = 0.016) and diastolic blood pressure (71 ± 2 mmHg vs. 68 ± 2 mmHg; P = 0.008) increased during GLP-1 treatment. Cardiac index (1.5 ± 0.1 l·min−1·m−2 vs. 1.7 ± 0.2 l·min−1·m−2; P = 0.54) and LVEF (30 ± 2% vs. 30 ± 2%; P = 0.93), tissue Doppler indexes, body weight, and BNP remained unchanged. Hypoglycemic events related to GLP-1 treatment were observed in eight patients. GLP-1 infusion increased circulating insulin levels and reduced plasma glucose concentration but had no major cardiovascular effects in patients without diabetes but with compensated HF. The impact of minor increases in heart rate and diastolic blood pressure during GLP-1 infusion requires further studies. Hypoglycemia was frequent and calls for caution in patients without diabetes but with HF.

974-P: Network Meta-analysis of Once Weekly Glucagon-Like Peptide-1 Receptor Agonists: A Focus on Cardiovascular Safety and Mortality

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 974-P
Author(s):  
OSAMAH ALFAYEZ ◽  
OMAR A. ALMOHAMMED ◽  
OMAR ALKHEZI ◽  
MAJED S. AL YAMI
Keyword(s):  
Meta Analysis ◽  
Cardiovascular Safety ◽  
Receptor Agonists ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Efficacy and tolerability of pharmacological interventions on metabolic disturbance induced by atypical antipsychotics in adults: A systematic review and network meta-analysis

2021 ◽  
pp. 026988112110353
Author(s):  
Yewei Wang ◽  
Dandan Wang ◽  
Jie Cheng ◽  
Xinyu Fang ◽  
Yan Chen ◽  
...  
Keyword(s):  
Body Weight ◽  
Atypical Antipsychotics ◽  
Randomized Clinical Trials ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Metabolic Disturbance ◽  
Pharmacological Interventions ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Meta Analyses

Background: There have been a few systematic reviews and conventional meta-analyses reporting effect of drugs on metabolic disturbance induced by atypical antipsychotics (AAPs). However, few of them provided sufficient and comprehensive comparisons between pharmacological interventions. Aims: We aimed to qualitatively compare drugs’ effect on AAPs-induced metabolic abnormalities by using network meta-analysis (NMA). Methods: We searched PubMed, EMBASE, Web of Science, Cochrane Controlled Register of Trials (CENTRAL), and PsycINFO on March 26, 2019. Of 5889 records identified, 61 randomized clinical trials including 3467 participants were included. We estimated weighted mean difference (WMD) and odds ratio (OR) using NMA. We assessed the risk of bias of individual studies with the Review Manager 5.3. Primary outcomes included change of body weight and body mass index (BMI). Secondary outcomes included change of other cardiometabolic risk factors, acceptability, and tolerability. Results: For body weight, topiramate (WMD −5.4, 95% CI −7.12 to −3.68), zonisamide (−3.44, 95% CI −6.57 to −0.36), metformin (−3.01, 95% CI −4.22 to −1.83), glucagon-like peptide-1 receptor agonists (GLP-1RAs) (−3.23, 95% CI −5.47 to −0.96), and nizatidine (−2.14, 95% CI −4.01 to −0.27) were significantly superior to placebo. Results regarding to BMI were similar to that of body weight. With respect to tolerability, only topiramate (OR 24, 95% CI 3.15 to 648) was inferior to placebo. Conclusions: Considering both efficacy and tolerability, evidence from this NMA indicates zonisamide, metformin, GLP-1RAs, and nizatidine in adults should be the first-line treatment for alleviating AAPs-induced weight gain or elevated BMI.

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