The Role of Glucagon-Like Peptide-1 Receptor Agonists in Type 2 Diabetes in Asia
- 69 Downloads
The improvement of glycemic control in patients with type 2 diabetes (T2D) is an urgent need in Asia. East Asian T2D patients have distinct characteristics, including relatively low body weight, early impairment of islet beta cell function with reduced insulin secretion and a marked increase in postprandial blood glucose levels. Control of postprandial hyperglycemia and beta cell preservation are key elements of the therapeutic strategy for these patients. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce HbA1c, fasting plasma glucose, and (in particular) postprandial glucose levels, and slow gastric emptying, while minimizing the risk of hypoglycemia and weight gain. Compared with long-acting GLP-1RAs, short-acting GLP-1RAs produce greater slowing of gastric emptying (which is a key factor driving the reduction of postprandial glycemia) and induce beta cell rest rather than promoting postprandial insulin secretion when used under physiological conditions. GLP-1RAs have greater efficacy in Asian than Caucasian patients. GLP-1RA add-on therapy provides clinically meaningful reductions in HbA1c and postprandial glucose in Asians with T2D inadequately controlled by oral antidiabetic drugs (OADs) or basal insulin ± OADs. Premixed insulin is often prescribed for T2D patients in China. A short-acting GLP-1RA plus basal insulin is an alternative to premixed insulin, resulting in better efficacy and a lower risk of hypoglycemia and weight gain. In conclusion, GLP-1RAs, especially short-acting GLP-1RAs, are a practical treatment option for East Asian patients with T2D inadequately controlled by OADs or basal insulin.
KeywordsAntidiabetic drugs Diabetes mellitus East Asia Exenatide Glucagon-like peptide-1 receptor agonist Glycemic control Lixisenatide Type 2 diabetes mellitus
This review and the article processing charges were funded by Sanofi. The author had full access to the information used to compile this work and takes complete responsibility for the integrity and accuracy of this review.
Medical Writing and Editorial Assistance
Medical writing and editorial assistance was provided by Kathy Croom and Steve Clissold of Content Ed Net and was funded by Sanofi.
The author meets the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article and takes responsibility for the integrity of the work as a whole, and has given his approval for this version to be published.
In addition to this project for Sanofi, Ju-Ming Lu reported receiving consulting fees from Novo Nordisk and lecture fees from Bayer, Merck, and Lilly.
Compliance with Ethics Guidelines
This mini review is based on previously conducted studies and does not contain any studies with human participants or animals performed by the authors.
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
- 16.Meier JJ, Rosenstock J, Hincelin-Méry A, et al. Contrasting effects of lixisenatide and liraglutide on postprandial glycemic control, gastric emptying, and safety parameters in patients with type 2 diabetes on optimized insulin glargine with or without metformin: a randomized, open-label trial. Diabetes Care. 2015;38:1263–73.CrossRefGoogle Scholar
- 24.Haneda M, Noda M, Origasa H, et al. Japanese clinical practice guideline for diabetes 2016. J Diabetes Investig. 2018. https://doi.org/10.1111/jdi.12810.
- 25.Chinese Diabetes Society. Chinese guideline for the prevention and treatment of type 2 diabetes mellitus (2017 edition). Chin J Diabetes Mellitus. 2018;10(1):4–67.Google Scholar
- 33.Zhang XM, Li PF, Hou JN, Ji LN. Blood glucose profiles in East Asian and Caucasian injection-naive patients with type 2 diabetes mellitus inadequately controlled on oral antihyperglycemic medication: pooled analysis of individual patient data. Diabetes Metab Res Rev. 2018;15:e3062.CrossRefGoogle Scholar
- 41.Seino Y, Min KW, Niemoeller E, Takami A, EFC10887 GETGOAL-L Asia Study Investigators. Randomized, double-blind, placebo-controlled trial of the once-daily GLP-1 receptor agonist lixisenatide in Asian patients with type 2 diabetes insufficiently controlled on basal insulin with or without a sulfonylurea (GetGoal-L-Asia). Diabetes Obes Metab. 2012;14:910–7.CrossRefGoogle Scholar
- 44.Božek T, Bilić-Ćurčić I, Berković MC, et al. The effectiveness of lixisenatide as an add on therapy to basal insulin in diabetic type 2 patients previously treated with different insulin regimes: a multi-center observational study. Diabetol Metab Syndr. 2018;13(10):16.Google Scholar