Cardiorenal benefits of GLP-1 receptor agonists in the treatment of type 2 diabetes mellitus

Czech version

Authors: Rid Dravecká
Authors‘ workplace: I. interná klinika LF UPJŠ a UNLP Košice
Published in: Diab Obez 2022; 22(43): 30-33
Category: Reviews

Overview

Chronic complications of diabetes mellitus (DM), including cardiovascular disease (CVD) and chronic kidney disease (CKD), are associated with increased patient mortality. The 2020 American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) recommendations suggest treatment with GLP-1 (glucagon- like peptide-1) receptor agonists (GLP-1 RAs) or sodium-glucose transporter 2 (SGLT2) inhibitors should be preferred in patients at high CV risk. GLP-1 RAs should also be considered in patients without confirmed CVD but with high risk indicators present. A meta-analysis of CV publications and trials with GLP-1 RAs confirmed a 12% reduction in MACE (Major Adverse Cardiovascular Events – hospitalization for heart failure, CV death, CKD progression). The REWIND study including diabetic patients with only 31.5% prevalence of previous CVD confirmed that dulaglutide reduced the risk of CV events compared to placebo in the first year, with a 36% reduction in HbA_1c able to contribute to the reduction in MACE and 64% of the benefit was unrelated to HbA_1c reduction. Diabetic kidney disease is a strong predictor of morbidity and premature mortality in diabetic patients. The chomost reliable evidence of positive renal effects of GLP-1 RAs comes from CV studies. Based on their meta-analysis, GLP-1 RAs treatment reduced the broader composite endpoint (development of macroalbuminuria, worsening renal function, end-stage renal failure, and death from renal causes) by 17%, mainly due to a reduction in albuminuria. Analysis of the REWIND trial under the secondary objective confirmed a 15% reduction in the renal component of the composite microvascular outcome. The most striking effect was on new macroalbuminuria and a sustained decrease in eGF. The protective effect of dulaglutide on renal outcomes is consistent with other studies with GLP-1 RAs, with only dulaglutide demonstrating a beneficial effect on eGF reduction. Early utilization of the benefits of GLP-1 RAs, beyond improving DM compensation, could prevent CV and renal complications and thus reduce morbidity and mortality in patients with T2DM.

Keywords:

Glomerular filtration rate – cardiovascular disease – diabetes mellitus – chronic kidney disease – GLP-1 receptor agonists – macroalbuminuria

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