Johns Hopkins Diabetes Center, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, 601 N Caroline Street, Baltimore, Maryland, USA 21287.
J Diabetes Res. 2023 Aug 8;2023:9972132. doi: 10.1155/2023/9972132. eCollection 2023.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are potent antihyperglycemic agents with beneficial effects on weight, cardiovascular, and renal outcomes. Physicians lack guidance as to which patients with insulin-requiring type 2 diabetes will respond best to GLP-1 RAs with respect to glycemic control, insulin dose reduction, and weight loss. This study evaluated the efficacy of GLP-1 RAs in patients with type 2 diabetes on insulin and patient factors that may predict a beneficial clinical response.
Adults with type 2 diabetes treated with insulin who had a GLP-1 RA added to their regimen were evaluated retrospectively. Baseline parameters and outcomes at 3, 6, and 12 months were collected.
Among the 81 patients included, there was a mean reduction in hemoglobin A1C of 0.94% (SD, 0.26; = 0.0007), 0.40% (SD, 0.21; = 0.0636), and 0.58% (SD, 0.23, = 0.0154) at 3, 6, and 12 months, respectively, following the addition of a GLP-1 RA. There was also a reduction in body weight noted at each time point. Baseline characteristics including BMI, duration of diabetes, and insulin requirement did not significantly affect A1C reduction when GLP-1 RA was added. At 3 months, patients with a random C-peptide that was normal (≥0.8 ng/ml) were significantly more likely to have discontinued insulin than those with random C-peptide that was low (<0.8 ng/ml) (11 of 23 vs. 0 of 7 patients, = 0.029).
The addition of a GLP-1 RA reduced HbA1C, weight, and insulin requirements in this cohort of patients with type 2 diabetes on insulin. BMI, baseline insulin dose, and diabetes duration did not predict response. A C-peptide level ≥ 0.8 ng/ml predicted a beneficial response after 3 months of therapy.
胰高血糖素样肽-1 受体激动剂（GLP-1 RAs）是一种强效的抗高血糖药物，对体重、心血管和肾脏结局有有益影响。医生对于需要胰岛素的 2 型糖尿病患者，哪种患者使用 GLP-1 RA 治疗能在血糖控制、胰岛素剂量减少和体重减轻方面有最佳反应，缺乏指导。本研究评估了 GLP-1 RA 在使用胰岛素的 2 型糖尿病患者中的疗效以及可能预测临床获益反应的患者因素。
回顾性评估了将 GLP-1 RA 添加到治疗方案中治疗的使用胰岛素的 2 型糖尿病成人患者。收集基线参数和治疗 3、6 和 12 个月时的结局。
在纳入的 81 例患者中，添加 GLP-1 RA 后，血红蛋白 A1C 分别平均降低了 0.94%（标准差，0.26； = 0.0007）、0.40%（标准差，0.21； = 0.0636）和 0.58%（标准差，0.23； = 0.0154），分别在 3、6 和 12 个月时。还观察到体重减轻。添加 GLP-1 RA 时，基线特征包括 BMI、糖尿病病程和胰岛素需求并未显著影响 A1C 降低。在 3 个月时，随机 C 肽正常（≥0.8 ng/ml）的患者比随机 C 肽低（<0.8 ng/ml）的患者更有可能停止使用胰岛素（23 例中有 11 例，7 例中无 1 例， = 0.029）。
在使用胰岛素的 2 型糖尿病患者中添加 GLP-1 RA 可降低 HbA1C、体重和胰岛素需求。BMI、基线胰岛素剂量和糖尿病病程不能预测反应。C 肽水平≥0.8 ng/ml 预测治疗 3 个月后有良好反应。
