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Prediction of response to GLP-1 receptor agonist therapy in Japanese patients with type 2 diabetes.

Imai K, Tsujimoto T, Goto A, Goto M, Kishimoto M, Yamamoto-Honda R, Noto H, Kajio H, Noda M - Diabetol Metab Syndr (2014)

Bottom Line: Here we compared the clinical characteristics and parameters reflecting glucose metabolism at the time of the initiation of GLP-1 receptor agonist therapy between patients who responded well to therapy and those who did not.The response was not significantly associated with the duration of diabetes or the glucagon stimulation test results.In patients with poorly controlled diabetes, the response to GLP-1 receptor agonist therapy was significantly associated with the treatment used before the initiation of therapy, the body mass index, and the mean preprandial blood glucose level during the 2 days after the initiation of therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.

ABSTRACT

Background: Glucagon-like peptide-1 (GLP-1) receptor agonists can maintain good glycemic control in some diabetic. Here we compared the clinical characteristics and parameters reflecting glucose metabolism at the time of the initiation of GLP-1 receptor agonist therapy between patients who responded well to therapy and those who did not.

Methods: The records of 43 patients with type 2 diabetes who started receiving GLP-1 receptor agonist therapy during hospitalization were retrospectively reviewed. Glucagon stimulation tests were performed, and patients were started on liraglutide or exenatide therapy. Preprandial blood glucose levels were measured on days 2 and 3 of GLP-1 receptor agonist therapy. We used the Cox proportional hazard model to compare clinical parameters between responders (HbA1c level <8% at more than 3 months after the initiation of treatment) and non-responders (HbA1c level ≥8% at more than 3 months after the initiation of treatment or a switch to insulin therapy at any time).

Results: Twenty-six of the 43 patients were classified as non-responders. At baseline, mean HbA1c levels were 9.9% among responders and 9.7% among non-responders. Compared with treatment with only diet or metformin, the hazard ratio [HR] for non-response was 5.3 (95% confidence interval [CI]: 1.16-24.6, P = 0.03) for insulin therapy and 5.0 (95% CI: 1.13-22.16, P = 0.03) for sulfonylurea therapy. Compared with the lowest tertile, the HRs for non-response in the highest tertile were 3.1 (95% CI: 1.04-8.97, P = 0.04) for the mean preprandial blood glucose level on days 2 and 3 and 3.4 (95% CI: 1.05-11.01, P = 0.04) for the body mass index. The response was not significantly associated with the duration of diabetes or the glucagon stimulation test results. A receiver operating curve analysis showed that the mean preprandial blood glucose level had the highest area under the curve value (=0.72) for the prediction of non-responders.

Conclusions: In patients with poorly controlled diabetes, the response to GLP-1 receptor agonist therapy was significantly associated with the treatment used before the initiation of therapy, the body mass index, and the mean preprandial blood glucose level during the 2 days after the initiation of therapy.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier estimates of the cumulative incidence of non-response to treatment, up to 600 days. (A) Previous antidiabetic treatment, (B) BMI: body mass index, (C) Duration of diabetes, (D) U-CPR: 24-h urinary C-peptide excretion, (E) CPR6: stimulated C-peptide level at 6 min during glucagon stimulation, (F) Average preprandial glucose level over 2 days after the initiation of GLP-1 receptor agonist treatment, GLP-1: Glucagon-like peptide-1.
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Fig1: Kaplan-Meier estimates of the cumulative incidence of non-response to treatment, up to 600 days. (A) Previous antidiabetic treatment, (B) BMI: body mass index, (C) Duration of diabetes, (D) U-CPR: 24-h urinary C-peptide excretion, (E) CPR6: stimulated C-peptide level at 6 min during glucagon stimulation, (F) Average preprandial glucose level over 2 days after the initiation of GLP-1 receptor agonist treatment, GLP-1: Glucagon-like peptide-1.

Mentions: There were no significant differences in sex, age, type of GLP-1 receptor agonist, or HbA1c level at the time of initiation of treatment between responders and non-responders. When a P level <0.05 was regarded as indicating a significant difference between groups, previous treatment other than diet or metformin was found to be a potential predictor of a non-response to GLP-1 receptor agonist therapy (Table 1). Furthermore, the BMI, duration of diabetes, and CPR6 and U-CPR levels were divided into tertiles to evaluate the effects of long-term factors on response, and the rate of treatment failure in each tertile was estimated using the Kaplan-Meier method (Figure 1).Figure 1


Prediction of response to GLP-1 receptor agonist therapy in Japanese patients with type 2 diabetes.

Imai K, Tsujimoto T, Goto A, Goto M, Kishimoto M, Yamamoto-Honda R, Noto H, Kajio H, Noda M - Diabetol Metab Syndr (2014)

Kaplan-Meier estimates of the cumulative incidence of non-response to treatment, up to 600 days. (A) Previous antidiabetic treatment, (B) BMI: body mass index, (C) Duration of diabetes, (D) U-CPR: 24-h urinary C-peptide excretion, (E) CPR6: stimulated C-peptide level at 6 min during glucagon stimulation, (F) Average preprandial glucose level over 2 days after the initiation of GLP-1 receptor agonist treatment, GLP-1: Glucagon-like peptide-1.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4209043&req=5

Fig1: Kaplan-Meier estimates of the cumulative incidence of non-response to treatment, up to 600 days. (A) Previous antidiabetic treatment, (B) BMI: body mass index, (C) Duration of diabetes, (D) U-CPR: 24-h urinary C-peptide excretion, (E) CPR6: stimulated C-peptide level at 6 min during glucagon stimulation, (F) Average preprandial glucose level over 2 days after the initiation of GLP-1 receptor agonist treatment, GLP-1: Glucagon-like peptide-1.
Mentions: There were no significant differences in sex, age, type of GLP-1 receptor agonist, or HbA1c level at the time of initiation of treatment between responders and non-responders. When a P level <0.05 was regarded as indicating a significant difference between groups, previous treatment other than diet or metformin was found to be a potential predictor of a non-response to GLP-1 receptor agonist therapy (Table 1). Furthermore, the BMI, duration of diabetes, and CPR6 and U-CPR levels were divided into tertiles to evaluate the effects of long-term factors on response, and the rate of treatment failure in each tertile was estimated using the Kaplan-Meier method (Figure 1).Figure 1

Bottom Line: Here we compared the clinical characteristics and parameters reflecting glucose metabolism at the time of the initiation of GLP-1 receptor agonist therapy between patients who responded well to therapy and those who did not.The response was not significantly associated with the duration of diabetes or the glucagon stimulation test results.In patients with poorly controlled diabetes, the response to GLP-1 receptor agonist therapy was significantly associated with the treatment used before the initiation of therapy, the body mass index, and the mean preprandial blood glucose level during the 2 days after the initiation of therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.

ABSTRACT

Background: Glucagon-like peptide-1 (GLP-1) receptor agonists can maintain good glycemic control in some diabetic. Here we compared the clinical characteristics and parameters reflecting glucose metabolism at the time of the initiation of GLP-1 receptor agonist therapy between patients who responded well to therapy and those who did not.

Methods: The records of 43 patients with type 2 diabetes who started receiving GLP-1 receptor agonist therapy during hospitalization were retrospectively reviewed. Glucagon stimulation tests were performed, and patients were started on liraglutide or exenatide therapy. Preprandial blood glucose levels were measured on days 2 and 3 of GLP-1 receptor agonist therapy. We used the Cox proportional hazard model to compare clinical parameters between responders (HbA1c level <8% at more than 3 months after the initiation of treatment) and non-responders (HbA1c level ≥8% at more than 3 months after the initiation of treatment or a switch to insulin therapy at any time).

Results: Twenty-six of the 43 patients were classified as non-responders. At baseline, mean HbA1c levels were 9.9% among responders and 9.7% among non-responders. Compared with treatment with only diet or metformin, the hazard ratio [HR] for non-response was 5.3 (95% confidence interval [CI]: 1.16-24.6, P = 0.03) for insulin therapy and 5.0 (95% CI: 1.13-22.16, P = 0.03) for sulfonylurea therapy. Compared with the lowest tertile, the HRs for non-response in the highest tertile were 3.1 (95% CI: 1.04-8.97, P = 0.04) for the mean preprandial blood glucose level on days 2 and 3 and 3.4 (95% CI: 1.05-11.01, P = 0.04) for the body mass index. The response was not significantly associated with the duration of diabetes or the glucagon stimulation test results. A receiver operating curve analysis showed that the mean preprandial blood glucose level had the highest area under the curve value (=0.72) for the prediction of non-responders.

Conclusions: In patients with poorly controlled diabetes, the response to GLP-1 receptor agonist therapy was significantly associated with the treatment used before the initiation of therapy, the body mass index, and the mean preprandial blood glucose level during the 2 days after the initiation of therapy.

No MeSH data available.


Related in: MedlinePlus