Can GLP-1 receptor agonists improve variation in blood glucose levels?

This study examined whether glucagon-like peptide-1 receptor agonists can reduce glucose variability in insulin-dependent patients with type 2 diabetes. The authors concluded that glucagon-like peptide-1 receptor agonists reduce glucose variability and weight while maintaining similar HbA1c levels.

HbA1c is a measure of average blood glucose (sugar) levels over 3 months. However, HbA1c levels do not reflect variation in glucose levels. Variable glucose levels have been associated with complications such as inflammation and abnormal heartbeat. Therefore, it is ideal to treat T2D patients with drugs which reduce glucose variation and also maintain a similar HbA1c.

Rapid-acting insulin (hormone necessary for breaking down glucose) has a rapid onset and reduces blood glucose levels after ingesting food. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) such as exenatide (Byetta) also lower blood glucose levels after ingesting food. These drugs work by increasing insulin secretion. It is thought that GLP-1 RAs result in greater improvements in glucose variability compared to rapid-acting insulin. It is also thought that GLP-1 RAs can reduce cardiometabolic risk factors (heart attack or stroke) compared to rapid-acting insulin.

This study aimed to determine whether GLP-1 RAs can reduce glucose variability and cardiometabolic risk markers in insulin-dependent T2D patients at high risk of cardiovascular disease.

This study involved 102 patients divided into 2 groups. One group received exenatide for 26 weeks while the other group were treated with rapid-acting insulin for 26 weeks. All patients were treated with metformin and basal (long-lasting) insulin.

After 26 weeks, glucose variability was lower in patients treated with GLP-1 RAs compared to rapid-acting insulin. HbA1c levels were similar among exenatide-treated patients (7.1%) and patients treated with rapid-acting insulin (7.2%). There was no difference in the number of hypoglycemic (dangerously low blood glucose levels) events between both groups.

After 26 weeks, body weight was lower in exenatide-treated patients (decrease of 4.8 kg) compared to patients treated with rapid-acting insulin (increase of 0.7 kg). Cardiometabolic markers were improved in exenatide-treated patients.

This study concluded that a GLP-1 RA reduces glucose variability and weight while maintaining similar HbA1c levels.

Although the average duration of diabetes was 15 years, it is unknown whether the results obtained would be similar in patients with a longer duration of diabetes.