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The Metabolic Medicine Postoperative Bariatric Surgery Consultation
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
This effect is particularly valuable if the patient is not requiring insulin. That is because the lack of insulin requirement implies that the patient is still producing enough insulin in their beta cells. Such a patient most likely became diabetic because of too much glucose delivery and too much insulin resistance. Not because of too little insulin. The GLP1 effect increases the insulin response to food. This is the reason for the name – incretin. It increases insulin secretion.
The Management of Patients with Heart Failure and Diabetes
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Studies have shown that the glucagon-like peptide-1 (GLP-1) agonist, liraglutide, is associated with lower rates of all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and non-fatal CVA. Liraglutide, however, failed to reduce HF hospitalizations.31 GLP-1 agonists stimulate the distal ileum to release GLP-1, which raises insulin levels while lowering glucagon, and promotes satiety by delaying gastric emptying.67 Contraindications to GLP-1 agonist use include hypersensitivity, end-stage renal disease, family or personal history of medullary thyroid cancer, or multiple endocrine neoplasia syndrome type 2 (MEN-2). Adverse events include resting tachycardia, increase in pancreatitis, mood disorders, and renal injury.68
Selected topics
Published in Henry J. Woodford, Essential Geriatrics, 2022
Glucagon-like peptide-1(GLP-1) agonists (e.g. liraglutide, exenatide and semaglutide) increase insulin secretion, suppress glucagon secretion and slow gastric emptying. They reduce HbA1C by around 11–14 mmol/mol (1%) in clinical trials.93,111 Lower adherence in ‘real-world' settings is likely to lead to smaller reductions (around 6 mmol/mol). They need to be administered as subcutaneous injections (between twice daily and once weekly, depending on formulation) but have a lower hypoglycaemia risk than insulin. Possible adverse effects include nausea/vomiting, reduced appetite, weight loss and pancreatitis.
Meta-analysis of cardiovascular outcome trials assessing the impact of glucagon-like peptide-1 receptor agonists on major cardiac arrhythmias
Published in Acta Cardiologica, 2023
Aristi Boulmpou, Dimitrios Patoulias, Christodoulos E. Papadopoulos, Eleftherios Teperikidis, Michael Doumas, Vassilios Vassilikos
GLP-1RAs gained growing attention during the last decade as novel, safe and well-tolerated regimens, currently established in the antidiabetic armamentarium [24]. Through a series of recent, large RCTs investigating the effect of GLP1-RAs on cardiovascular outcomes, a significant cardiovascular benefit for diabetic subjects with cardiac disease was suggested, while GLP-1RAs seem to additionally lower the overall cardiovascular risk in diabetic subjects in high risk for cardiac complications [8–11]. All considered, our meta-analysis indicates that antidiabetic treatment with GLP-1RAs does not hold a significant impact on ameliorating arrhythmogenesis in the context of T2DM. For all we know, this is the first meta-analysis of the recent large cardiovascular outcome trials focussing on the various types of cardiac arrhythmias, a fact that further empowers our findings.
Ethanol extract of the mushroom Coprinus comatus exhibits antidiabetic and antioxidant activities in streptozotocin-induced diabetic rats
Published in Pharmaceutical Biology, 2022
Nuniek Ina Ratnaningtyas, Hernayanti Hernayanti, Nuraeni Ekowati, Fajar Husen
Glucagon-like peptide-1 (GLP-1) is a gastrointestinal hormone that plays a critical role in the intestine’s glucose metabolism and acts as an insulinotropic hormone (i.e., stimulator of insulin secretion) (Zhang et al. 2019). GLP-1’s effectiveness and levels decline to suboptimal levels in DM due to inhibition by the enzyme dipeptidyl peptidase-4 (DPP-4), which rapidly degrades GLP-1, resulting in its very short lifespan. The bioactive alkaloids in C. comatus function as DPP-4 inhibitors by enhancing the uninterrupted flow of GLP-1 and accelerating phosphatidylinositol (PI) 3-kinase (PI-3K) activity, which enhances insulin biosynthesis and cell proliferation (Drucker 2007; Shukla and Srinivasan 2012). Previous research confirmed that the ethyl acetate extract of C. comatus 500 mg was effective in increasing levels of GLP-1 (Husen et al. 2021).
The GLP-1 receptor in airway inflammation in asthma: a promising novel target?
Published in Expert Review of Clinical Immunology, 2021
Ashley Y. Wu, R. Stokes Peebles
In the last two decades, glucagon-like peptide-1 (GLP-1) receptor agonists have emerged as promising therapeutics for diabetes mellitus, a disease with increasing global burden – 34 million in the US, 422 million worldwide [1]. GLP-1 is part of a family of neuroendocrine peptide hormones known as incretins that are produced by intestinal L-cells as well as certain neurons within the brainstem in response to nutrient ingestion [2]. GLP-1 helps maintain euglycemia by inducing endogenous insulin secretion from pancreatic beta cells and suppressing glucagon secretion. GLP-1 also delays gastric emptying and causes increased satiety, which can lead to intentional weight loss when utilized in a supraphysiologic manner. The appeal of GLP-1 receptor (GLP-1R) agonists as an antiglycemic agent is that they act to decrease blood sugar in a glucose-dependent manner, thereby decreasing risk of hypoglycemic episodes and mitigating weight gain. Currently, GLP-1R agonists are approved by the US Food and Drug Administration (FDA) to treat type 2 diabetes mellitus (T2D) and weight loss in obesity (Table 1).