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2017 ; 19
(12
): 1645-1654
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A review of glucagon-like peptide-1 receptor agonists and their effects on
lowering postprandial plasma glucose and cardiovascular outcomes in the treatment
of type 2 diabetes mellitus
#MMPMID28474401
Owens DR
; Monnier L
; Hanefeld M
Diabetes Obes Metab
2017[Dec]; 19
(12
): 1645-1654
PMID28474401
show ga
Type 2 diabetes mellitus (T2DM) is an independent risk factor for cardiovascular
(CV) comorbidities, with CV disease being the most common cause of death in
adults with T2DM. Although glucocentric therapies may improve glycaemic control
(as determined by glycated haemoglobin levels), evidence suggests that this
approach alone has limited beneficial effects on CV outcomes relative to
improvements in lipid and blood pressure control. This may be explained in part
by the fact that current antidiabetic treatment regimens primarily address
overall glycaemia and/or fasting plasma glucose, but not the postprandial plasma
glucose (PPG) excursions that have a fundamental causative role in increasing CV
risk. This literature review evaluates the relationship between PPG and the risk
of CV disease, discusses the treatment of T2DM with glucagon-like peptide-1
receptor agonists (GLP-1 RAs) and examines the associated CV outcomes. The
literature analysis suggests that exaggerated PPG excursions are a risk factor
for CV disease because of their adverse pathophysiologic effects on the
vasculature, resulting in increased all-cause and CV-related mortality. Although
GLP-1 RAs are well established in the current T2DM treatment paradigm, a subgroup
of these compounds has a particularly pronounced, persistent and short-lived
effect on gastric emptying and, hence, lower PPG substantially. However, current
long-term data on CV outcomes with GLP-1 RAs are contradictory, with both
beneficial and adverse effects having been reported. This review explores the
opportunity to direct treatment towards controlling PPG excursions, thereby
improving not only overall glycaemic control but also CV outcomes.