RESUMEN
BACKGROUND: With the increasing prevalence of obesity and type 2 diabetes, the availability of different treatment options remains essential. Studies comparing the outcomes of glucagon-like peptide 1 receptor agonists with those of metabolic bariatric surgery in patients with type 2 diabetes and obesity are lacking. METHODS: Using propensity score matching, based on data from several nationwide clinical registries, patients who underwent primary metabolic bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) were matched with patients who received glucagon-like peptide 1 receptor agonists. Outcome measures included the occurrence of major cardiovascular events, microvascular complications, and potential side effects (alcohol/substance abuse, self-harm, and fractures). RESULTS: Over a mean follow-up of 7 years, major cardiovascular events occurred in 191 of 2039 patients (cumulative incidence 14.5%) in the surgery group compared with 247 of 2039 patients (19.6%) in the glucagon-like peptide 1 receptor agonist group (HR 0.75 (95% c.i. 0.62 to 0.91), P = 0.003). Patients in the surgery group had lower haemoglobin A1c values 5 years after treatment (mean difference 9.82 (95% c.i. 8.51 to 11.14)â mmol/mol, P < 0.001) and fewer microvascular complications (retinopathy HR 0.88 (95% c.i. 0.79 to 0.99), P = 0.039; nephropathy HR 0.72 (95% c.i. 0.66 to 0.80), P < 0.001; and neuropathy or leg ulcers HR 0.82 (95% c.i. 0.74 to 0.92), P < 0.001), but a higher risk of alcohol/substance abuse (HR 2.56 (95% c.i. 1.87 to 3.50), P < 0.001), self-harm (HR 1.41 (95% c.i. 1.17 to 1.71), P < 0.001), and fractures (HR 1.86 (95% c.i. 1.11 to 3.12), P = 0.019). CONCLUSION: Compared with glucagon-like peptide 1 receptor agonist treatment, metabolic bariatric surgery is associated with superior metabolic outcomes and a lower risk of major cardiovascular events in patients with type 2 diabetes and obesity, but a higher risk of alcohol/substance abuse, self-harm, and fractures.
Asunto(s)
Cirugía Bariátrica , Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Agonistas Receptor de Péptidos Similares al Glucagón , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cirugía Bariátrica/efectos adversos , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Obesidad/complicaciones , Obesidad Mórbida/cirugía , Obesidad Mórbida/complicaciones , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Puntaje de Propensión , Resultado del Tratamiento , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Agonistas Receptor de Péptidos Similares al Glucagón/uso terapéuticoAsunto(s)
Agonistas Receptor de Péptidos Similares al Glucagón , Ideación Suicida , Femenino , Humanos , Masculino , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/psicología , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Suicidio/estadística & datos numéricos , Suicidio/psicologíaRESUMEN
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are effective in diabetes and obesity, reducing hyperglycemia by increasing insulin release and delaying gastric emptying. However, they can cause gastroparesis, raising concerns about aspiration during procedures. Recent guidelines advise discontinuing GLP-1 RA before surgery to reduce the risk of pulmonary aspiration. AIM: To evaluate the effect of GLP-1 RAs on gastric residual contents during endoscopic procedures. METHODS: A retrospective chart review at BronxCare Health System, New York, from January 2019 to October 2023, assessed gastric residue and aspiration in GLP-1 RA patients undergoing endoscopic procedures. Two groups were compared based on dietary status before the procedure. Data included demographics, symptoms of gastroparesis, opiate use, hemoglobin A1c, GLP-1 agonist indication, endoscopic details, and aspiration occurrence. IBM SPSS was used for analysis, calculating means, standard deviations, and applying Pearson's chi-square and t-tests for associations, with P < 0.05 as being significant. RESULTS: During the study, 306 patients were included, with 41.2% on a clear liquid/low residue diet and 58.8% on a regular diet before endoscopy. Most patients (63.1%) were male, with a mean age of 60 ± 12 years. The majority (85.6%) were on GLP-1 RAs for diabetes, and 10.1% reported digestive symptoms before endoscopy. Among those on a clear liquid diet, 1.5% had residual food at endoscopy compared to 10% on a regular diet, which was statistically significant (P = 0.03). Out of 31 patients with digestive symptoms, 13% had residual food, all from the regular diet group (P = 0.130). No complications were reported during or after the procedures. CONCLUSION: The study reflects a significant rise in GLP-1 RA use for diabetes and obesity. A 24-hour liquid diet seems safe for endoscopic procedures without aspiration. Patients with upper gastrointestinal symptoms might have a higher residual food risk, though not statistically significant. Further research is needed to assess risks based on diabetes duration, gastroparesis, and GLP-1 RA dosing, aiming to minimize interruptions in therapy during procedures.
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Gastroparesia , Agonistas Receptor de Péptidos Similares al Glucagón , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Endoscopía Gastrointestinal/efectos adversos , Endoscopía Gastrointestinal/métodos , Vaciamiento Gástrico/efectos de los fármacos , Gastroparesia/epidemiología , Gastroparesia/etiología , Gastroparesia/prevención & control , Agonistas Receptor de Péptidos Similares al Glucagón/administración & dosificación , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Estudios RetrospectivosAsunto(s)
Fármacos Antiobesidad , Cirugía Bariátrica , Agonistas Receptor de Péptidos Similares al Glucagón , Obesidad , Humanos , Fármacos Antiobesidad/administración & dosificación , Fármacos Antiobesidad/efectos adversos , Fármacos Antiobesidad/economía , Cirugía Bariátrica/estadística & datos numéricos , Receptor del Péptido 1 Similar al Glucagón/agonistas , Agonistas Receptor de Péptidos Similares al Glucagón/administración & dosificación , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Agonistas Receptor de Péptidos Similares al Glucagón/economía , Mal Uso de los Servicios de Salud/estadística & datos numéricos , Cobertura del Seguro/economía , Seguro de Salud/economía , Seguro de Salud/estadística & datos numéricos , Obesidad/tratamiento farmacológico , Obesidad/economía , Obesidad/cirugía , Pérdida de Peso/efectos de los fármacosAsunto(s)
Fármacos Antiobesidad , Agonistas Receptor de Péptidos Similares al Glucagón , Obesidad , Humanos , Fármacos Antiobesidad/administración & dosificación , Fármacos Antiobesidad/efectos adversos , Obesidad/dietoterapia , Obesidad/tratamiento farmacológico , Obesidad/economía , Pérdida de Peso/efectos de los fármacos , Agonistas Receptor de Péptidos Similares al Glucagón/administración & dosificación , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Agonistas Receptor de Péptidos Similares al Glucagón/economía , Dieta Saludable/economía , Asistencia Alimentaria/economíaAsunto(s)
Fármacos Antiobesidad , Asistencia Alimentaria , Obesidad , Humanos , Fármacos Antiobesidad/administración & dosificación , Fármacos Antiobesidad/efectos adversos , Dieta Saludable , Agonistas Receptor de Péptidos Similares al Glucagón/administración & dosificación , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Obesidad/dietoterapia , Obesidad/tratamiento farmacológico , Pérdida de Peso/efectos de los fármacosAsunto(s)
Diabetes Mellitus Tipo 2 , Agonistas Receptor de Péptidos Similares al Glucagón , Insuficiencia Cardíaca , Hipoglucemiantes , Obesidad , Humanos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Péptidos Similares al Glucagón/uso terapéutico , Péptidos Similares al Glucagón/efectos adversos , Insuficiencia Cardíaca/etiología , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Obesidad/complicaciones , Obesidad/tratamiento farmacológico , Obesidad/cirugía , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Agonistas Receptor de Péptidos Similares al Glucagón/uso terapéutico , Cirugía BariátricaRESUMEN
BACKGROUND: Semaglutide is increasingly used in the management of type 2 diabetes mellitus and obesity. Ensuring the safety of this medication is crucial for its clinical use. This meta-analysis evaluates the safety profile of semaglutide across patient populations and treatment durations. METHODS: Randomized controlled trials assessing the safety of semaglutide vs. placebo, with specified treatment durations were identified. The primary outcome was occurrence of any cardiovascular adverse events. Secondary outcomes included sudden cardiac death, adverse events leading to death, adverse events, gastrointestinal side effects, occurrence of hypoglycemia, and new-onset neoplasm. RESULTS: A total of 23 studies met the inclusion criteria with a combined sample size of 57,911 participants. The meta-analysis revealed that the adverse event associated with semaglutide is gastrointestinal in nature (nausea and vomiting). No significant differences were observed between semaglutide and comparator groups. CONCLUSION: Semaglutide appears to have a favorable safety profile across diverse patient populations and treatment durations, supporting its continued use in the management of type 2 diabetes mellitus and obesity. It is generally well-tolerated, with a low incidence of adverse events. Clinicians should be aware of these findings and monitor patients accordingly. Further long-term studies are warranted to assess the safety of semaglutide in clinical practice.
Asunto(s)
Diabetes Mellitus Tipo 2 , Agonistas Receptor de Péptidos Similares al Glucagón , Péptidos Similares al Glucagón , Femenino , Humanos , Masculino , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Péptidos Similares al Glucagón/efectos adversos , Péptidos Similares al Glucagón/uso terapéutico , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Obesidad/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Agonistas Receptor de Péptidos Similares al Glucagón/uso terapéuticoRESUMEN
This Medical News article discusses reports of falsified semaglutide being found around the world.
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Medicamentos Falsificados , Agonistas Receptor de Péptidos Similares al Glucagón , Péptidos Similares al Glucagón , Humanos , Medicamentos Falsificados/provisión & distribución , Fraude/legislación & jurisprudencia , Fraude/prevención & control , Salud Global , Organización Mundial de la Salud , Péptidos Similares al Glucagón/efectos adversos , Péptidos Similares al Glucagón/provisión & distribución , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Agonistas Receptor de Péptidos Similares al Glucagón/provisión & distribuciónAsunto(s)
Diabetes Mellitus Tipo 2 , Cardiomiopatías Diabéticas , Nefropatías Diabéticas , Agonistas Receptor de Péptidos Similares al Glucagón , Hipoglucemiantes , Insuficiencia Renal Crónica , Humanos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Nefropatías Diabéticas/tratamiento farmacológico , Nefropatías Diabéticas/etiología , Nefropatías Diabéticas/mortalidad , Nefropatías Diabéticas/prevención & control , Aprobación de Drogas , Receptor del Péptido 1 Similar al Glucagón/agonistas , Péptidos Similares al Glucagón/uso terapéutico , Péptidos Similares al Glucagón/efectos adversos , Péptidos Similares al Glucagón/administración & dosificación , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Agonistas Receptor de Péptidos Similares al Glucagón/administración & dosificación , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Agonistas Receptor de Péptidos Similares al Glucagón/uso terapéutico , Insuficiencia Renal Crónica/tratamiento farmacológico , Insuficiencia Renal Crónica/etiología , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/prevención & control , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/prevención & control , Cardiomiopatías Diabéticas/etiología , Cardiomiopatías Diabéticas/mortalidad , Cardiomiopatías Diabéticas/prevención & control , Inyecciones Subcutáneas , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Glucagon-like Peptide-1 Receptor Agonists (GLP-1RAs) have demonstrated efficacy in improving mortality and cardiovascular (CV) outcomes. However, the impact of GLP-1RAs therapy on cardiorenal outcomes of diabetic patients at the commencement of dialysis remains unexplored. PURPOSE: This study aimed to investigate the long-term benefits of GLP-1RAs in type 2 diabetic patients at dialysis commencement. METHODS: A cohort of type 2 diabetic patients initializing dialysis was identified from the TriNetX global database. Patients treated with GLP-1RAs and those treated with long-acting insulin (LAI) were matched by propensity score. We focused on all-cause mortality, four-point major adverse cardiovascular events (4p-MACE), and major adverse kidney events (MAKE). RESULTS: Among 82,041 type 2 diabetic patients initializing dialysis, 2.1% (n = 1685) patients were GLP-1RAs users (mean ages 59.3 years; 55.4% male). 1682 patients were included in the propensity-matched group, treated either with GLP-1RAs or LAI. The main causes of acute dialysis in this study were ischemic heart disease (17.2%), followed by heart failure (13.6%) and sepsis (6.5%). Following a median follow-up of 1.4 years, GLP-1RAs uses at dialysis commencement was associated with a reduced risk of mortality (hazard ratio [HR] = 0.63, p < 0.001), 4p-MACE (HR = 0.65, p < 0.001), and MAKE (HR = 0.75, p < 0.001). This association was particularly notable in long-acting GLP-1RAs users, with higher BMI, lower HbA1c, and those with eGFR > 15 ml/min/1.73m2. GLP-1RAs' new use at dialysis commencement was significantly associated with a lower risk of MACE (p = 0.047) and MAKE (p = 0.004). Additionally, GLP-1RAs use among those who could discontinue from acute dialysis or long-term RAs users was associated with a lower risk of mortality, 4p-MACE, and MAKE. CONCLUSION: Given to the limitations of this observational study, use of GLP-1RAs at the onset of dialysis was associated with a decreased risk of MACE, MAKE, and all-cause mortality. These findings show the lack of harm associated with the use of GLP-1RAs in diabetic patients at the initiation of acute dialysis.
Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Nefropatías Diabéticas , Agonistas Receptor de Péptidos Similares al Glucagón , Hipoglucemiantes , Diálisis Renal , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Biomarcadores/sangre , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Causas de Muerte , Bases de Datos Factuales , Diabetes Mellitus Tipo 2/mortalidad , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/sangre , Nefropatías Diabéticas/mortalidad , Nefropatías Diabéticas/terapia , Nefropatías Diabéticas/diagnóstico , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Agonistas Receptor de Péptidos Similares al Glucagón/uso terapéutico , Hipoglucemiantes/uso terapéutico , Hipoglucemiantes/efectos adversos , Diálisis Renal/mortalidad , Diálisis Renal/efectos adversos , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Diabetes Mellitus Tipo 2 , Agonistas Receptor de Péptidos Similares al Glucagón , Humanos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Hígado Graso/tratamiento farmacológico , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Agonistas Receptor de Péptidos Similares al Glucagón/uso terapéutico , Enfermedad del Hígado Graso no Alcohólico/tratamiento farmacológico , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Resultado del TratamientoRESUMEN
PURPOSE OF REVIEW: People with schizophrenia experience three to five times higher prevalence of diabetes and obesity than the general population, contributing to a 20-year reduced lifespan. The impacts of weight gain extend beyond physical health, affecting people's self-esteem, quality of life, and triggering treatment nonadherence, leading to relapse and deteriorations in health. Clinical guidelines recommend patients with antipsychotic-induced weight gain are treated with cognitive behaviour therapy and lifestyle changes; however, effective treatments for obesity in schizophrenia are critically lacking. Glucagon-like peptide-1 receptor agonists (GLP-RAs) have shown large effects in weight loss in the general population; however, effects are less clear in people with schizophrenia. This review aims to assess the clinical trials that have been completed, are in progress, and directions for future trials. RECENT FINDINGS: To date, six clinical trials have been completed, four of which have published their findings. Three further trials are currently in progress. SUMMARY: Results from completed trials suggest that GLP-1RAs decrease weight in people with schizophrenia, however effect sizes are mostly smaller than studies based on the general population. Future trials could focus on dual or triple agonist agents, and/or explore the effects of GLP-1âs at antipsychotic medication commencement, to potentially prevent antipsychotic weight gain.
Asunto(s)
Agonistas Receptor de Péptidos Similares al Glucagón , Obesidad , Esquizofrenia , Pérdida de Peso , Humanos , Antipsicóticos/efectos adversos , Agonistas Receptor de Péptidos Similares al Glucagón/administración & dosificación , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Obesidad/inducido químicamente , Obesidad/tratamiento farmacológico , Esquizofrenia/tratamiento farmacológico , Pérdida de Peso/efectos de los fármacos , Ensayos Clínicos como AsuntoRESUMEN
AIMS: Package labeling for weight loss formulations of semaglutide and liraglutide include a warning for suicidal thoughts and behaviors. The objective was to examine the association between glucagon-like peptide-1 receptor agonists (GLP-1RA) and incident depression. METHODS: This retrospective cohort study compared Veterans Health Administration patients initiated on a GLP-1RA versus a dipeptidyl peptidase-4 inhibitor (DPP-4i) between June 1, 2013 and June 30, 2020. The primary outcome was incident depression, defined as a new diagnosis of depression or new antidepressant prescription, within 1 year following drug initiation. Multivariable log-binomial regression was used to estimate relative risk, adjusted for confounding factors including patient demographics, comorbid conditions, and prior medication. RESULTS: Of 34,130 patients initiated on a GLP-1RA and 105,478 initiated on a DPP-4i, incident depression occurred in 7.7â¯% (n= 2263) and 6.3â¯% (n= 6602), respectively. After adjustment, the relative risk was 1.02 (95â¯% CI: 0.97 - 1.07), thus failing to demonstrate a significant increase in risk for incident depression following initiation of a GLP-1RA compared to DPP-4i. Relative risk estimates in all sensitivity analyses were also non-significant. CONCLUSIONS: This study did not demonstrate a significant increase in risk for incident depression following GLP-1RA initiation.
Asunto(s)
Depresión , Agonistas Receptor de Péptidos Similares al Glucagón , Hipoglucemiantes , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Antidepresivos/efectos adversos , Antidepresivos/uso terapéutico , Depresión/diagnóstico , Depresión/epidemiología , Péptidos Similares al Glucagón/análogos & derivados , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Incidencia , Incretinas/efectos adversos , Incretinas/uso terapéutico , Liraglutida/uso terapéutico , Liraglutida/efectos adversos , Estudios Retrospectivos , Medición de Riesgo , Factores de Tiempo , Estados Unidos/epidemiología , United States Department of Veterans Affairs , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Agonistas Receptor de Péptidos Similares al Glucagón/uso terapéuticoAsunto(s)
Anestesia General , Agonistas Receptor de Péptidos Similares al Glucagón , Hipoglucemiantes , Aspiración Respiratoria de Contenidos Gástricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Receptor del Péptido 1 Similar al Glucagón/agonistas , Agonistas Receptor de Péptidos Similares al Glucagón/administración & dosificación , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Agonistas Receptor de Péptidos Similares al Glucagón/uso terapéutico , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Complicaciones Posoperatorias/etiología , Riesgo , Procedimientos Quirúrgicos Electivos , Anestesia General/efectos adversos , Anestesia General/métodos , Anestesia/efectos adversos , Anestesia/métodos , Aspiración Respiratoria de Contenidos Gástricos/inducido químicamente , Aspiración Respiratoria de Contenidos Gástricos/etiología , Aspiración Respiratoria de Contenidos Gástricos/prevención & control , Privación de Tratamiento , Urgencias MédicasAsunto(s)
Agonistas Receptor de Péptidos Similares al Glucagón , Hipoglucemiantes , Aspiración Respiratoria de Contenidos Gástricos , Estómago , Humanos , Receptor del Péptido 1 Similar al Glucagón/agonistas , Agonistas Receptor de Péptidos Similares al Glucagón/administración & dosificación , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Agonistas Receptor de Péptidos Similares al Glucagón/farmacología , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Complicaciones Posoperatorias , Riesgo , Aspiración Respiratoria de Contenidos Gástricos/etiología , Estómago/diagnóstico por imagen , Estómago/efectos de los fármacos , Tamaño de los Órganos/efectos de los fármacos , Ultrasonografía , Ensayos Clínicos Controlados Aleatorios como Asunto , Urgencias Médicas , Procedimientos Quirúrgicos OperativosAsunto(s)
Agonistas Receptor de Péptidos Similares al Glucagón , Receptor del Péptido 1 Similar al Glucagón , Enfermedades Respiratorias , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Receptor del Péptido 1 Similar al Glucagón/agonistas , Agonistas Receptor de Péptidos Similares al Glucagón/administración & dosificación , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Agonistas Receptor de Péptidos Similares al Glucagón/uso terapéutico , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Complicaciones Posoperatorias/inducido químicamente , Complicaciones Posoperatorias/etiología , Riesgo , Periodo Preoperatorio , Enfermedades Respiratorias/inducido químicamente , Enfermedades Respiratorias/etiologíaAsunto(s)
Agonistas Receptor de Péptidos Similares al Glucagón , Hipoglucemiantes , Enfermedades Respiratorias , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Receptor del Péptido 1 Similar al Glucagón/agonistas , Agonistas Receptor de Péptidos Similares al Glucagón/administración & dosificación , Agonistas Receptor de Péptidos Similares al Glucagón/efectos adversos , Agonistas Receptor de Péptidos Similares al Glucagón/uso terapéutico , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Complicaciones Posoperatorias/inducido químicamente , Enfermedades Respiratorias/inducido químicamente , Riesgo , Periodo PreoperatorioRESUMEN
BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) is a leading cause of cancer death. HCC is preventable with about 70% of HCC attributable to modifiable risk factors. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), Food and Drug Administration-approved medications for treating type 2 diabetes mellitus (T2DM), have pleiotropic effects on counteracting risk factors for HCC. Here we evaluate the association of GLP-1RAs with incident HCC risk in a real-world population. METHODS: This retrospective cohort included 1,890,020 patients with a diagnosis of T2DM who were prescribed GLP-1RAs or other non-GLP-1RA anti-diabetes medications and had no prior diagnosis of HCC. Incident (first-time) diagnosis of HCC and hepatic decompensating events during a 5-year follow-up was compared between cohorts of patients prescribed GLP-1 RAs vs other anti-diabetes medications. Time-to-first-event analysis was performed using Kaplan-Meier survival analysis with hazard ratio and 95% confidence interval calculated. RESULTS: GLP-1RAs were associated with a lower risk of incident HCC with hazard ratio of 0.20 [0.14-0.31], 0.39 [0.21-0.69], 0.63 [0.26-1.50] compared with insulin, sulfonylureas, and metformin, respectively. GLP-1RAs were associated with a significantly lower risk of hepatic decompensation compared with 6 other anti-diabetes medications. Reduced risks were observed in patients without and with different stages of fatty liver diseases, with more profound effects in patients without liver diseases. Similar findings were observed in patients with and without obesity and alcohol or tobacco use disorders. GLP-1RA combination therapies were associated with decreased risk for HCC and hepatic decompensations compared with monotherapies. CONCLUSIONS: GLP-1RAs were associated with a reduced risk of incident HCC and hepatic decompensation compared with other anti-diabetes medications in patients with T2DM. These findings provide supporting evidence for future studies to investigate the underlying mechanisms and their clinical use.