Effect of Glucagon-like Peptide-1 Receptor Agonists on Fat Distribution in Patients with Type 2 Diabetes: A Systematic Review and Meta-analysis
Background: Glucagon-like peptide-1 receptor agonists (GLP-1Ras) are widely used to treat type 2 diabetes. They not only reduce glucose, but also have a positive effect on weight loss. However, few studies have reported the effect of GLP-1Ras on fat distribution.
Methods: PubMed, Cochrane, Embase, and ClinicalTrials.gov were searched for randomized controlled trials on GLP-1Ras and type 2 diabetes, published from inception to June 2021. Our main outcomes were the reductions of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Other anthropometric outcomes were also assessed. We used the Cochrane Collaboration tools to assess the risk of bias in the included studies. The quality of the evidence was assessed using the GRADE profiler version 3.6. Review Manager 5.4.1 and STATA 16.0 were used for data analysis.
Results: Ten studies involving 541 patients were included. Compared with the control groups, the GLP-1Ras groups showed reductions in VAT (SMD = -0.54, 95% CI [ -0.92, -0.17], I2 = 79%, P=0.005) and SAT (SMD = -0.44, 95% CI [ -0.60, -0.27], I2 =44%, P<0.00001). In addition, body weight (WMD= -3.59, 95% CI [ -4.30, -2.88], I2 =0%, P<0.00001), waist circumference (WC) (WMD= -3.09, 95% CI [ -4.66, -1.52], I2 =70%, P=0.0001), and body mass index (BMI) (WMD= -1.11, 95% CI [ -1.35, -0.86], I2 =47%, P<0.00001) were significantly decreased. According to the GRADE approach, the level of evidence was low or moderate.
Conclusion: This study highlights that GLP-1Ras, especially liraglutide and exenatide, may play an active role in fat distribution in patients with type 2 diabetes. After treatment with GLP-1Ras, both VAT and SAT decreased, and the decrease of VAT was numerically greater than that of SAT.
Home Use of Mini-Dose Glucagon As a Novel Treatment for Hypoglycemia Following Repeated, Prolonged Fasts in Type 1 Diabetes During Ramadan
Objective: We determined the efficacy of self-administered subcutaneous mini-dose glucagon (MDG) to treat fasting-induced hypoglycemia in type 1 diabetes (T1D).
Research design and methods: This was a 4-week randomized, controlled crossover trial of 2-week MDG or 2-week oral glucose tablets (OG, control) involving 17 adults with T1D during Ramadan.
Results: Compared with OG, MDG demonstrated a significant higher change in blood glucose from baseline to 30 min (Δt30, P < 0.001) and 1 h (Δt60, P = 0.02). The efficacy of MDG was preserved following ≥8 h fasting with significantly higher Δt30 in MDG (P = 0.01). Over the entire 2 weeks, MDG period had increased time in 70-180 mg/dL (P = 0.009) and less time <70 mg/dL (P = 0.04). MDG use resulted in higher completion of fasts compared with OG (P < 0.001).
Conclusions: MDG administration is an effective alternative to OG for prevention and treatment of fasting-induced hypoglycemia, offering improved glycemic control and promoting successful completion of prolonged fasts.
Glucagon-Like Peptide-1 Receptor Agonist Use in People Living with Type 2 Diabetes Mellitus and Chronic Kidney Disease: A Narrative Review of the Key Evidence with Practical Considerations
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are incretin-mimetic agents that are effective adjuncts in the treatment of diabetes. This class of medications is also associated with promoting weight loss and a low risk of hypoglycemia, and some have been shown to be associated with a significant reduction of major cardiovascular events. Mounting evidence suggests that GLP-1 RAs have benefits beyond reducing blood glucose that include improving kidney function in people living with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD), a common microvascular complication of T2DM. Several large clinical studies, the majority of which are cardiovascular outcome trials, indicate that GLP-1 RA therapy is safe and tolerable for people living with T2DM and compromised renal function, and also suggest that GLP-1 RAs may have renoprotective properties.
Although evidence from clinical trials has shown GLP-1 RAs to be safe and efficacious in people living with T2DM and renal impairment, their use is uncommon in this patient population. With continuing developments in the field of GLP-1 RA therapy, it is important for physicians to understand the benefits and practical use of GLP-1 RAs, as well as the clinical evidence, in order to achieve positive patient outcomes. Here, we review evidence on GLP-1 RA use in people living with T2DM and CKD and summarize renal outcomes from clinical studies. We provide practical considerations for GLP-1 RA use to provide an added benefit to guide treatment in this high-risk patient population.
Emergency Glucagon: a Focused Review of Psychosocial Experiences of Rescue Drugs for Type 1 Diabetes
Purpose of review: The purpose of this paper is to describe rescue glucagon types, safety, efficacy, and preferences, as well as to review articles regarding emergency glucagon usage, severe hypoglycemia, and the emotions of both phenomena. We conducted a review of current literature on glucagon usage and the emotional impact of severe hypoglycemia on people with diabetes (PwD) and the caregivers of people with type 1 diabetes (T1D).
Recent findings: Minimal research exists pertaining to glucagon and severe hypoglycemic experiences in PwD, which is troubling considering the severity of risks and possible side effects. Recent articles described negative emotions such as fear, anxiety, stress, helplessness, shame, embarrassment, loneliness, frustration, hopefulness, and uncertainty surrounding glucagon usage. There is scarce research regarding PwD’s emotions surrounding severe hypoglycemia and rescue glucagon use. Additional research is needed to investigate the emotions and feelings people with T1D and their caregivers’ experience pertaining to severe hypoglycemia and emergency glucagon use.
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| E8ET1702-20 | EnoGene | 100ul | 275 EUR |
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| AP83452 | SAB | 1mg | 2640 EUR |
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| AP83569 | SAB | 1mg | 2640 EUR |
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| AP83570 | SAB | 1mg | 2640 EUR |
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| AP83594 | SAB | 1mg | 2640 EUR |
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| AP83735 | SAB | 1mg | 2640 EUR |
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| AP84179 | SAB | 1mg | 2640 EUR |
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| AP84422 | SAB | 1mg | 2640 EUR |
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| 7-02218 | CHI Scientific | 4mg | Ask for price |
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| 7-02219 | CHI Scientific | 10mg | Ask for price |
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| 7-02220 | CHI Scientific | 50mg | Ask for price |
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| MA1047 | Antagene | 100μg | 260 EUR |
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| MA1047-M | Antagene | 100μg | 290 EUR |
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| MA1047-S | Antagene | 100μg | 290 EUR |
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| GWB-5CD1AB | GenWay Biotech | 0.01 mg | Ask for price |
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| hor-237 | ProSpec Tany | 100µg | 60 EUR |
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| hor-286 | ProSpec Tany | 4mg | 350 EUR |
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| HY-P0082 | MedChemExpress | 50mg | 1282.8 EUR |
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| MO15083 | Neuromics | 100 ug | 459.6 EUR |
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| RP-1507 | Alpha Diagnostics | 4 mg | 708 EUR |
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| MBS8564776-01mL | MyBiosource | 0.1mL | 345 EUR |
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| MBS8564776-01mLAF405L | MyBiosource | 0.1mL(AF405L) | 565 EUR |
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| MBS8564776-01mLAF405S | MyBiosource | 0.1mL(AF405S) | 565 EUR |
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| MBS8564776-01mLAF610 | MyBiosource | 0.1mL(AF610) | 565 EUR |
Omarigliptin/galangin combination mitigates lipopolysaccharide-induced neuroinflammation in rats: Involvement of glucagon-like peptide-1, toll-like receptor-4, apoptosis and Akt/GSK-3β signaling
Aims: The objectives of this work were to assess the possibility of administration of omarigliptin and/or galangin to combat lipopolysaccharide (LPS)-induced neuroinflammation in rats and to explore the possible mechanisms that might contribute to their actions.
Materials and methods: In a rat model of LPS-induced neuroinflammation, the changes in the behavioral tests, biochemical parameters, and the histopathological picture were assessed.
Key findings: Administration of either omarigliptin or galangin to LPS-injected rats was able to significantly improve the behavioral changes with restoration of the oxidant/antioxidant balance, decrement of toll-like receptor-4 levels, and amelioration of the neuroinflammation associated with inhibition of apoptosis and restoration of glucagon-like peptide-1 levels in the cerebral tissues. In addition, omarigliptin and/or galangin significantly reduced the levels of phospho-Akt and glycogen synthase kinase 3 beta (GSK-3β) and significantly increased the expression of beclin-1 in the cerebral tissues compared versus the group treated with LPS alone. As a result, these changes were positively reflected on the histopathological and the electron microscopic picture of the cerebral tissues. These admirable effects were maximally evidenced in rats treated with omarigliptin/galangin combination relative to the use of either omarigliptin or galangin alone.
Significance: Omarigliptin/galangin combination might be proposed as a promising therapeutic line for mitigation of the pathophysiologic events of LPS-induced neuroinflammation.