RESUMEN
Patients with type 2 diabetes mellitus (T2DM) are at increased risk for severe coronavirus disease 2019 (COVID-19) and related mortality. Glucagon-like peptide-1 receptor agonists (GLP-1-RAs) have significant cardiovascular and renal benefits for patients with T2DM and related comorbidities. Their anti-inflammatory properties could be beneficial in these patients. This work provides less-biased estimates regarding the risk for respiratory tract infections and acute respiratory distress syndrome by performing the first significant meta-analysis of cardiovascular outcome trials in the literature. Notably, GLP-1-RAs do not seem to increase the risk for respiratory tract infection, pneumonia, or acute respiratory distress syndrome in patients with T2DM and cardiovascular comorbidities.
RESUMEN
OBJECTIVE: Although it is assumed that novel-derived anthropometric indices can better reflect cardiometabolic risk than traditional ones, the results are conflicting. Previous studies have mainly focused on patients with type 2 diabetes mellitus. However, studies conducted on populations with prediabetes are scarce. The present study aimed to examine the potential relationship between prediabetes and novel anthropometric parameters [that is, cardiometabolic index (CMI), visceral adiposity index (VAI), lipid accumulation product index (LAP), body roundness index (BRI), and body adiposity index (BAI)] and traditional parameters [that is, waist circumference (WC), hip circumference (HC), body mass index (BMI), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR)] in adults with prediabetes. PATIENTS AND METHODS: This case-control cross-sectional study included 177 patients with prediabetes and 609 control subjects. Biochemical and simple anthropometric parameters were measured (WC, HC, body weight, and height), whereas the other parameters were calculated. RESULTS: WC, CMI, VAI, and LAP independently correlated with prediabetes. Principal component analysis (PCA) was used to extract several factors that correlated with prediabetes. Significant predictive capability was demonstrated for non-traditional anthropometric/lipid-related factors and WHipR-related factors for prediabetes (OR=1.334 and OR=1.202, respectively). However, only non-traditional anthropometric/lipid-related factors (i.e., VAI, CMI, and LAP) demonstrated an independent significant positive relationship with prediabetes in multivariate binary regression analysis. CONCLUSIONS: CMI, VAI, and LAP could be superior to BAI, BRI, and conventional anthropometric parameters for discriminating patients with prediabetes in the adult population. Prospective trials are needed to confirm our results.
Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Estado Prediabético , Adulto , Humanos , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Estado Prediabético/diagnóstico , Estudios Transversales , Estudios Prospectivos , Obesidad/epidemiología , Índice de Masa Corporal , Adiposidad , Circunferencia de la Cintura , Obesidad Abdominal/epidemiología , Enfermedades Cardiovasculares/epidemiología , Lípidos , Factores de RiesgoRESUMEN
Patients with type 2 diabetes mellitus (T2DM) are at increased risk for severe coronavirus disease 2019 (COVID-19) and related mortality. Glucagon-like peptide-1 receptor agonists (GLP-1-RAs) have significant cardiovascular and renal benefits for patients with T2DM and related comorbidities. Their anti-inflammatory properties could be beneficial in these patients. This work provides less-biased estimates regarding the risk for respiratory tract infections and acute respiratory distress syndrome by performing the first significant meta-analysis of cardiovascular outcome trials in the literature. Notably, GLP-1-RAs do not seem to increase the risk for respiratory tract infection, pneumonia, or acute respiratory distress syndrome in patients with T2DM and cardiovascular comorbidities.
Asunto(s)
COVID-19 , Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Síndrome de Dificultad Respiratoria , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Diabetes Mellitus Tipo 2/inducido químicamente , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Péptido 1 Similar al Glucagón , Receptor del Péptido 1 Similar al Glucagón/agonistas , Humanos , Hipoglucemiantes/efectos adversos , Pandemias , Síndrome de Dificultad Respiratoria/tratamiento farmacológicoRESUMEN
OBJECTIVE: As sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are second-line treatment options in type 2 diabetes mellitus (T2DM), our study sought to provide precise effect estimates regarding the role of GLP-1RAs vs SGLT-2is as add-on treatments in patients uncontrolled by metformin monotherapy. RESEARCH DESIGN AND METHODS: PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL) and 'grey literature' were searched from their inception up to December 2019 for randomized controlled trials (RCTs) with durations≥12weeks to evaluate the safety and efficacy of adding a GLP-1RA vs an SGLT-2i in patients with T2DM. RESULTS: Three eligible RCTs were identified. Administration of GLP-1RAs vs SGLT-2is resulted in significant decreases in HbA1c with no significant impact on either body weight or fasting plasma glucose. GLP-1RA treatment led to a significant increase in odds for achieving an HbA1c<7% compared with SGLT-2is, whereas no difference was detected in body weight reductions of>5%. Significantly greater risk for any hypoglycaemia, nausea and diarrhoea, and lower risk for genital infections, was also observed with GLP-1RAs, while no differences regarding severe hypoglycaemia, treatment discontinuation and impact on blood pressure levels were identified. No other major safety issues arose. CONCLUSION: Our meta-analysis suggests that GLP-1RAs provide better glycaemic effects than SGLT-2is in patients with T2DM uncontrolled by metformin, albeit while increasing risk for hypoglycaemia and gastrointestinal adverse events.
Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Receptor del Péptido 1 Similar al Glucagón/agonistas , Hipoglucemiantes/uso terapéutico , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Diarrea/inducido químicamente , Diarrea/epidemiología , Quimioterapia Combinada , Hemoglobina Glucada/metabolismo , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/epidemiología , Metformina/uso terapéutico , Náusea/inducido químicamente , Náusea/epidemiología , Infecciones del Sistema Genital/epidemiologíaRESUMEN
Los pacientes con diabetes mellitus tipo 2 (DMT2) presentan un mayor riesgo de experimentar una enfermedad grave por coronavirus 2019 (COVID-19) con un incremento de la mortalidad relacionada. Los agonistas del receptor del péptido similar al glucagón tipo 1 (AR-GLP-1) ejercen efectos cardiovasculares y renales beneficiosos en los pacientes con DMT2 de alto riesgo cardiovascular. Sus propiedades antiinflamatorias podrían resultar beneficiosas en estos pacientes. El presente estudio es un metaanálisis sobre el riesgo de infección respiratoria y distrés respiratorio del adulto causado por AR-GLP-1 utilizando como fuente los ensayos clínicos de seguridad cardiovascular publicados en la bibliografía. Hay que destacar que los AR-GLP-1 no parecen aumentar el riesgo de infección respiratoria, neumonía ni síndrome de distrés respiratorio del adulto en los pacientes con DMT2 y alto riesgo cardiovascular (AU)
Patients with type 2 diabetes mellitus (T2DM) are at increased risk for severe coronavirus disease 2019 (COVID-19) and related mortality. Glucagon-like peptide-1 receptor agonists (GLP-1-RAs) have significant cardiovascular and renal benefits for patients with T2DM and related comorbidities. Their anti-inflammatory properties could be beneficial in these patients. This work provides less-biased estimates regarding the risk for respiratory tract infections and acute respiratory distress syndrome by performing the first significant meta-analysis of cardiovascular outcome trials in the literature. Notably, GLP-1-RAs do not seem to increase the risk for respiratory tract infection, pneumonia, or acute respiratory distress syndrome in patients with T2DM and cardiovascular comorbidities (AU)