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Microvascular effects of glucagon-like peptide-1 receptor agonists in type 2 diabetes: a meta-analysis of randomized controlled trials.
Acta Diabetol. 2017 Oct; 54(10):933-941.AD

Abstract

AIMS

Results with GLP1-receptor agonists (GLP-1RA) on microvascular complications of diabetes are contrasting. In trials designed for cardiovascular outcomes, both liraglutide and semaglutide were associated with a relevant reduction in the incidence and progression of nephropathy. On the other hand, in the same trials, semaglutide was associated with an increased progression of retinopathy, and a similar trend was observed for liraglutide. This meta-analysis is aimed at assessing the effects of GLP-1RA on retinopathy and nephropathy.

METHODS

A Medline search for GLP-1 receptor agonists (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, or semaglutide) was performed, collecting all randomized clinical trials with a duration >11 weeks, enrolling patients with type 2 diabetes, and comparing a GLP-1 receptor agonist with placebo or any other non-GLP-1 receptor agonist drug.

RESULTS

Of the 113 trials fulfilling the inclusion criteria, 78 and 62 did not report information on retinopathy and nephropathy, respectively. Treatment with GLP1-RA was not associated with a significant increase in the incidence of retinopathy (MH-OR [95% CI] 0.92 [0.74-1.16]. p = 0.49). In subgroup analyses, GLP1-RA were associated with a lower risk of retinopathy in comparison with sulfonylureas. Cases of macular edema were reported only in nine trials with no sign of increased risk. GLP1-RA reduced the incidence of nephropathy with respect to comparators (MH-OR [95% CI] 0.74 [0.60-0.92]. p = 0.005). This difference was significant versus placebo, but not versus any class of active comparators.

CONCLUSIONS

GLP1-RA appear to reduce the incidence and/or progression of nephropathy and to have no specific effect on retinopathy-with the notable exception of semaglutide, which could have a negative impact on the retina.

Authors+Show Affiliations

Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy.Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy.Diabetology Unit, Ospedale San Donato Arezzo, Arezzo, Italy.Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy.Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy. matteo.monami@unifi.it.

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

28748377

Citation

Dicembrini, Ilaria, et al. "Microvascular Effects of Glucagon-like Peptide-1 Receptor Agonists in Type 2 Diabetes: a Meta-analysis of Randomized Controlled Trials." Acta Diabetologica, vol. 54, no. 10, 2017, pp. 933-941.
Dicembrini I, Nreu B, Scatena A, et al. Microvascular effects of glucagon-like peptide-1 receptor agonists in type 2 diabetes: a meta-analysis of randomized controlled trials. Acta Diabetol. 2017;54(10):933-941.
Dicembrini, I., Nreu, B., Scatena, A., Andreozzi, F., Sesti, G., Mannucci, E., & Monami, M. (2017). Microvascular effects of glucagon-like peptide-1 receptor agonists in type 2 diabetes: a meta-analysis of randomized controlled trials. Acta Diabetologica, 54(10), 933-941. https://doi.org/10.1007/s00592-017-1031-9
Dicembrini I, et al. Microvascular Effects of Glucagon-like Peptide-1 Receptor Agonists in Type 2 Diabetes: a Meta-analysis of Randomized Controlled Trials. Acta Diabetol. 2017;54(10):933-941. PubMed PMID: 28748377.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microvascular effects of glucagon-like peptide-1 receptor agonists in type 2 diabetes: a meta-analysis of randomized controlled trials. AU - Dicembrini,Ilaria, AU - Nreu,Besmir, AU - Scatena,Alessia, AU - Andreozzi,Francesco, AU - Sesti,Giorgio, AU - Mannucci,Edoardo, AU - Monami,Matteo, Y1 - 2017/07/27/ PY - 2017/05/16/received PY - 2017/07/16/accepted PY - 2017/7/28/pubmed PY - 2018/6/7/medline PY - 2017/7/28/entrez KW - GLP-1 receptor agonists KW - Meta-analysis KW - Nephropathy KW - Retinopathy SP - 933 EP - 941 JF - Acta diabetologica JO - Acta Diabetol VL - 54 IS - 10 N2 - AIMS: Results with GLP1-receptor agonists (GLP-1RA) on microvascular complications of diabetes are contrasting. In trials designed for cardiovascular outcomes, both liraglutide and semaglutide were associated with a relevant reduction in the incidence and progression of nephropathy. On the other hand, in the same trials, semaglutide was associated with an increased progression of retinopathy, and a similar trend was observed for liraglutide. This meta-analysis is aimed at assessing the effects of GLP-1RA on retinopathy and nephropathy. METHODS: A Medline search for GLP-1 receptor agonists (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, or semaglutide) was performed, collecting all randomized clinical trials with a duration >11 weeks, enrolling patients with type 2 diabetes, and comparing a GLP-1 receptor agonist with placebo or any other non-GLP-1 receptor agonist drug. RESULTS: Of the 113 trials fulfilling the inclusion criteria, 78 and 62 did not report information on retinopathy and nephropathy, respectively. Treatment with GLP1-RA was not associated with a significant increase in the incidence of retinopathy (MH-OR [95% CI] 0.92 [0.74-1.16]. p = 0.49). In subgroup analyses, GLP1-RA were associated with a lower risk of retinopathy in comparison with sulfonylureas. Cases of macular edema were reported only in nine trials with no sign of increased risk. GLP1-RA reduced the incidence of nephropathy with respect to comparators (MH-OR [95% CI] 0.74 [0.60-0.92]. p = 0.005). This difference was significant versus placebo, but not versus any class of active comparators. CONCLUSIONS: GLP1-RA appear to reduce the incidence and/or progression of nephropathy and to have no specific effect on retinopathy-with the notable exception of semaglutide, which could have a negative impact on the retina. SN - 1432-5233 UR - https://www.unboundmedicine.com/medline/citation/28748377/Microvascular_effects_of_glucagon_like_peptide_1_receptor_agonists_in_type_2_diabetes:_a_meta_analysis_of_randomized_controlled_trials_ L2 - https://dx.doi.org/10.1007/s00592-017-1031-9 DB - PRIME DP - Unbound Medicine ER -