Title:Role of GLP-1 Analogs in the Management of Diabetes and its Secondary
Complication
Volume: 21
Issue: 20
Author(s): Ponnurengam Malliappan Sivakumar, B. Premkumar *, Veluchamy Prabhawathi and Pranav Kumar Prabhakar*
Affiliation:
- Department of Pharmacology, K. K College of Pharmacy, Gerugambakkam, Chennai, Tamil Nadu, India
- Department of Medical Laboratory Sciences, Lovely Professional University, Punjab, India-144411
Keywords:
Glucagon like peptide-1, dipeptidyl-peptidase, diabetes, neuropathy, retinopathy, microvascular complications.
Abstract: Abstract: The cardiovascular complications of Type 2 Diabetes Mellitus (T2DM) including myocardial
infarction, heart failure, peripheral vascular disease and, stroke and retinopathy, nephropathy and
neuropathy are microvascular complications. While the newer therapies like glitazones or even Dipeptidyl-
peptidase-IV (DPP-IV) inhibitors increase the risk of therapy, the Glucagon Like Peptide-1 Receptor
Agonists (GLP-1RAs), were reported as suitable alternates. The GLP-1RAs reduce Major Adverse
Cardiovascular Events (MACE), have anti-atherogenic potential, and possess pleiotropic activity.
The GLP-1RAs were found to improve neuroprotection, enhance neuronal growth, reduce the incidence
of stroke, and improve central insulin resistance. The GLP-1RAs are beneficial in improving the
glycemic profile, preventing macroalbuminuria and reducing the decline in eGFR and enhancing renal
protection. The renal benefits of add-on therapy of GLP-1RAs with SGLT-2 inhibitors have composite
renal outcomes such as suppression of inflammatory pathways, improvement in natriuresis, diuresis,
found to be nephroprotective. Improvement in glycemic control with a reduction in body weight and
intraglomerular pressure and prevention of tubular injury makes the GLP-1RAs as suitable add-on
therapies in improving cardiorenal outcomes. Obesity, an important contributor to insulin resistance
and a reduction in weight, is an essential therapeutic option in addressing diabetic-obesity. It also reduces
the damage to blood-retinal-barrier, thus beneficial in halting the development of diabetic retinopathy.
In diabetic complications, glycemic control, addressing insulin resistance through weight
loss, controlling atherosclerosis through anti-inflammatory effects and cardio-renal-neuro protection,
makes GLP-1RAs a suitable therapeutic strategy on long-term treatment of T2DM. This review discusses
the role of GLP-1RAs in diabetes, the dosage, mono or combination therapy with other antidiabetics
in long-term treatment and its effect in uncontrolled diabetes.
