Markers of ß-Cell Failure Predict Poor Glycemic Response to GLP-1 Receptor Agonist Therapy in Type 2 Diabetes  

Oleh:

Jones, Angus G. ; McDonald, Timothy J. ; Shields, Beverley M. ; Hill, Anita V. ; Hyde, Christopher J.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Diabetes Care vol. 39 no. 02 (Feb. 2016), page 250-257.
Topik: Type 2 Diabetes
Fulltext: D05 v39 n2 p250 kelik2017.pdf (1,019.39KB)

Ketersediaan

Perpustakaan FK Nomor Panggil: D05.K Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

OBJECTIVE To assess whether clinical characteristics and simple biomarkers of ß-cell failure are associated with individual variation in glycemic response to GLP-1 receptor agonist (GLP-1RA) therapy in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS We prospectively studied 620 participants with type 2 diabetes and HbA1c =58 mmol/mol (7.5%) commencing GLP-1RA therapy as part of their usual diabetes care and assessed response to therapy over 6 months. We assessed the association between baseline clinical measurements associated with ß-cell failure and glycemic response (primary outcome HbA1c change 0–6 months) with change in weight (0–6 months) as a secondary outcome using linear regression and ANOVA with adjustment for baseline HbA1c and cotreatment change. RESULTS Reduced glycemic response to GLP-1RAs was associated with longer duration of diabetes, insulin cotreatment, lower fasting C-peptide, lower postmeal urine C-peptide–to–creatinine ratio, and positive GAD or IA2 islet autoantibodies (P = 0.01 for all). Participants with positive autoantibodies or severe insulin deficiency (fasting C-peptide =0.25 nmol/L) had markedly reduced glycemic response to GLP-1RA therapy (autoantibodies, mean HbA1c change -5.2 vs. -15.2 mmol/mol [-0.5 vs. -1.4%], P = 0.005; C-peptide <0.25 nmol/L, mean change -2.1 vs. -15.3 mmol/mol [-0.2 vs. -1.4%], P = 0.002). These markers were predominantly present in insulin-treated participants and were not associated with weight change. CONCLUSIONS Clinical markers of low ß-cell function are associated with reduced glycemic response to GLP-1RA therapy. C-peptide and islet autoantibodies represent potential biomarkers for the stratification of GLP-1RA therapy in insulin-treated diabetes.

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