Abstract
Purpose
The progressive nature of type 2 diabetes mellitus (T2DM) calls for step-wise intensification
of therapy for maintaining normal glycemic levels and lowering cardiovascular (CV)
risk. Because obesity is a prominent risk factor and comorbidity of T2DM, it further
elevates the CV risk in T2DM. Therefore, it is vital to manage weight, obesity, and
glycemic parameters for effective T2DM management. Few oral antidiabetic drugs (sulfonylureas
and thiazolidinediones) and insulin are not suitable for obese patients with T2DM
because these drugs cause weight gain. The present review discusses the place of glucagon-like
peptide-1 receptor agonists (GLP-1RAs) in the treatment of obese patients with T2DM
and the significance of these drugs in the prevention of future CV risk in patients
with T2DM.
Methods
A literature search of PubMed and EMBASE was conducted by using the search terms T2DM, GLP-1RAs, obesity, and cardiovascular complication. Randomized controlled trials measuring the effect of GLP-1RAs versus that of placebo
on CV outcomes were included in the review.
Findings
GLP-1RAs have emerged as a therapeutic alternative; these drugs exert their actions
by providing glycemic control, improving insulin resistance and ö̇-cell function,
and reducing weight. The risk of hypoglycemia with GLP-1RAs is minimal; however, GLP-1RAs
are associated with gastrointestinal adverse events and raise concerns regarding pancreatitis.
Combining GLP-1RAs with insulin analogues results in higher efficacy, a lowered insulin
dose, and reduced insulin-related hypoglycemia and weight gain. Longer acting GLP-1RAs
are also associated with improvement in medication adherence. Improvement in CV risk
factors such as blood pressure and lipid profile further increases their usability
for improving CV outcomes.
Implications
Overall, the properties of GLP-1RAs make them suitable for combination with oral antidiabetic
drugs in the early stages of T2DM and with insulins in the later stages for optimizing
comprehensive management of the disease.
Key words
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Article info
Publication history
Published online: May 16, 2017
Accepted:
March 15,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
