Diabetes: incretin-based therapies tied to beneficial effects of β-cell function and improved insulin resistance

  • Wu S & al.
  • Diabetes Obes Metab
  • 9 Dec 2018

  • curated by Sarfaroj Khan
  • UK Medical News
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A meta-analysis published in the journal Diabetes, Obesity & Metabolism found that incretin-based therapies such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dipeptidyl peptidase-4 inhibitors (DPP-4Is) not only reduce homeostasis model assessment for insulin resistance (HOMA-IR) and fasting plasma glucose (FPG) level but also improve HOMA for beta cell function (HOMA-β) and fasting C-peptide level in patients with type 2 diabetes mellitus (T2DM).

Researchers conducted a search across Medline, Embase and other databases and identified 360 randomised controlled trials (n=1,57,696) that compared incretin-based therapies with six other classes of glucose-lowering drugs or with placebo.

Results of meta-analysis showed that GLP-1RAs and DPP-4Is showed improvement in HOMA-β (weighted mean difference [WMD], 20.31; 95% CI, 16.34-24.39; low quality and WMD, 9.90; 95% CI, 8.27-11.61; moderate quality, respectively) and fasting C-peptide level (WMD, 0.16 ng/mL; 95% CI, 0.03-0.29; low quality and WMD, 0.09 ng/mL; 95% CI, 0.04-0.14; moderate quality, respectively) vs placebo. A significant reduction was seen with GLP-1RAs and DPP-4Is in HOMA-IR (WMD, −0.67; 95% CI, −1.08 to −0.27 and WMD, −0.23; 95% CI, −0.38 to −0.08; low quality, respectively) and FPG (WMD, −1.04 mmol/L; 95% CI, −1.26 to −0.83 and WMD = −0.77 mmol/L; 95% CI, −0.98 to −0.57; moderate quality, respectively) vs placebo.

The authors suggested: “Although Grading of Recommendations Assessment, Development and Evaluation (GRADE) scores showed low to moderate evidence for most comparisons, incretin-based therapies seem to be a suitable option for long-term treatment of T2DM and to preserve β-cell function.”