Nonglycemic Effects of GLP-1 Agonists: From a Starling to Lizards to People

Inflammation and Oxidative Stress in Diabetic Kidney Disease: The Targets for SGLT2 Inhibitors and GLP-1 Receptor Agonists

The incidence of type 2 diabetes (T2D) has been increasing worldwide, and diabetic kidney disease (DKD) remains one of the leading long-term complications of T2D. Several lines of evidence indicate that glucose-lowering agents prevent the onset and progression of DKD in its early stages but are of limited efficacy in later stages of DKD. However, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor (GLP-1R) agonists were shown to exert nephroprotective effects in patients with established DKD, i.e., those who had a reduced glomerular filtration rate. These effects cannot be solely attributed to the improved metabolic control of diabetes. In our review, we attempted to discuss the interactions of both groups of agents with inflammation and oxidative stress—the key pathways contributing to organ damage in the course of diabetes. SGLT2i and GLP-1R agonists attenuate inflammation and oxidative stress in experimental in vitro and in vivo models of DKD in several ways. In addition, we have described experiments showing the same protective mechanisms as found in DKD in non-diabetic kidney injury models as well as in some tissues and organs other than the kidney. The interaction between both drug groups, inflammation and oxidative stress appears to have a universal mechanism of organ protection in diabetes and other diseases.

Assessing the Continuation of Glucagon-Like Peptide-1 Receptor Agonists When Weight and HBA1C Are Not Reduced

Background: Glucagon-like peptide-1 agonists (GLP-1) reportedly lower HbA1c and promote weight reduction and improve cardiovascular outcomes. The primary objective of this study was to evaluate the use of GLP-1 agents in patients and changes in HbA1c, weight loss, blood pressure, and lipoid profiles. Methods: Patient information was extracted from a regional Veteran Affairs data mart. Patients were included if they had prescriptions for at least 90 days of a GLP-1 between April 1, 2005, and December 1, 2016, and HbA1Cs and weights at both baseline and within first 15 months of therapy. Blood pressure and lipids were also measured. Pearson's correlation and multiple regression analysis were used. Results: Three hundred twenty-two patients met inclusion criteria. Average HbA1c decreased by 0.81% and weight by 4.4 kg. At 1 year, 160 patients had both weight and HbA1c measured, and of those, 92 (58%) patients had HbA1c reduction of at least 0.5% and 94 (59%) patients had <-2 kg change in weight. Fifty-seven (36%) patients met both of those outcomes. Veterans who met both weight and HbA1c outcomes were slightly, but significantly, older than those who did not meet both. No correlation was found between weight and HbA1c change at each quarter (P > 0.05); however, weight change was correlated with systolic blood pressure change (P = 0.03). Multiple regression for meeting weight and HbA1c target outcomes, and changes at quarters 1-3, all correlated to success at 1 year (P < 0.05). Conclusions: Weight change was independent of HbA1c changes in patients receiving GLP-1s for diabetes control. Weight loss was associated with decreases in systolic BP.