Markers of β-Cell Failure Predict Poor Glycemic Response to GLP-1 Receptor Agonist Therapy in Type 2 Diabetes
| Autor: | Angus G, Jones, Timothy J, McDonald, Beverley M, Shields, Anita V, Hill, Christopher J, Hyde, Bridget A, Knight, Andrew T, Hattersley, Claire, Buckley |
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| Rok vydání: | 2015 |
| Předmět: |
Blood Glucose
Male medicine.medical_specialty Endocrinology Diabetes and Metabolism medicine.medical_treatment Type 2 diabetes Glucagon-Like Peptide-1 Receptor Article chemistry.chemical_compound Insulin-Secreting Cells Internal medicine Diabetes mellitus Internal Medicine medicine Humans Hypoglycemic Agents Insulin Prospective Studies Glucagon-like peptide 1 receptor Aged Glycemic Advanced and Specialized Nursing Creatinine C-Peptide business.industry C-peptide Body Weight Weight change Fasting Middle Aged Postprandial Period medicine.disease Endocrinology Diabetes Mellitus Type 2 chemistry Female business |
| Zdroj: | Diabetes Care. 39:250-257 |
| ISSN: | 1935-5548 0149-5992 |
| DOI: | 10.2337/dc15-0258 |
| Popis: | OBJECTIVE To assess whether clinical characteristics and simple biomarkers of β-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 β-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 CONCLUSIONS Clinical markers of low β-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. |
| Databáze: | OpenAIRE |
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