The postprandial actions of GLP-1 receptor agonists: The missing link for cardiovascular and kidney protection in type 2 diabetes

• Published in: Cell metabolism 2023-02, Vol.35 (2), p.253-273
• Main Authors: Thomas, Merlin C., Coughlan, Melinda T., Cooper, Mark E.
• Format: Article
• Language: English
• Subjects: cardioprotection; cardiovascular outcomes; Cardiovascular System; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; diabetic complications; GLP-1 receptor; GLP-1 receptor agonist; glucagon-like peptide-1; Glucagon-Like Peptide-1 Receptor - agonists; Humans; Hypoglycemic Agents - therapeutic use; Kidney; major acute cardiovascular event; renoprotection; type 2 diabetes
• ISSN: 1550-4131; 1932-7420
• DOI: 10.1016/j.cmet.2023.01.004

Recent clinical trials in people with type 2 diabetes have demonstrated beneficial actions on heart and kidney outcomes following treatment with GLP-1RAs. In part, these actions are consistent with improved glucose control and significant weight loss. But GLP-1RAs may also have additive benefits by improving postprandial dysmetabolism. In diabetes, dysregulated postprandial nutrient excursions trigger inflammation, oxidative stress, endothelial dysfunction, thrombogenicity, and endotoxemia; alter hormone levels; and modulate cardiac output and regional blood and lymphatic flow. In this perspective, we explore the actions of GLP-1RAs on the postprandial state and their potential role in end-organ benefits observed in recent trials. Treatment with GLP-1RAs has been associated with beneficial actions on heart and kidney outcomes in recent clinical trials. Beyond improvements in glucose control and significant weight loss, Thomas et al. argue that the GLP-1RAs may also have additive benefits by improving postprandial dysmetabolism in people with type 2 diabetes.