The use of GLP‐1 receptor agonists in hospitalised patients: An untapped potential

Abstract

SummaryIn the outpatient setting, glucagon‐like peptide‐1 (GLP‐1) receptor agonists have proved to be highly efficacious drugs that provide glycaemic control with a low risk of hypoglycaemia. These characteristics make GLP‐1 receptor agonists attractive agents to treat dysglycaemia in perioperative or high‐dependency hospital settings, where glycaemic variability and hyperglycaemia are associated with poor prognosis. GLP‐1 also has a direct action on the myocardium and vasculature—which may be advantageous in the immediate aftermath of a vascular insult. This is a narrative review of the work in this area. The aim was to determine the populations of hospitalised patients being evaluated and the clinical and mechanistic end‐points tested, with the institution of GLP‐1 therapy in hospital. We searched the PubMed, Embase, and Google scholar databases, combining the term “glucagon‐like peptide 1” OR “GLP‐1” OR “incretin” OR “liraglutide” OR “exenatide” OR “lixisenatide” OR “dulaglutide” OR “albiglutide” AND “inpatient” OR “hospital” OR “perioperative” OR “postoperative” OR “surgery” OR “myocardial infarction” OR “stroke” OR “cerebrovascular disease” OR “transient ischaemic attack” OR “ICU” OR “critical care” OR “critical illness” OR “CCU” OR “coronary care unit.” Pilot studies were reported in the fields of acute stroke, cardiac resuscitation, coronary care, and perioperative care that showed advantages for GLP‐1 therapy, with normalisation of glucose, lower glucose variability, and lower risk of hypoglycaemia. Animal and human studies have reported improvements in myocardial performance when given acutely after vascular insult or surgery, but these have yet to be translated into randomised clinical trials.

Perspectives of Antidiabetic Drugs in Diabetes With Coronavirus Infections

“…Given that beneficial roles of GLP-1RAs for the prevention of cardiovascular and kidney diseases have been well established (Prattichizzo et al, 2019), these drugs could be an ideal option for the treatment of patients with DM at such risk (Ceriello et al, 2020). Of note, GLP-1RAs therapy was associated with reduction of hypoglycemia and glucose variability in the intensive care unit (ICU) setting, which could be protective in the critically ill patients (Mustafa and Whyte, 2019). However, initiating or maintaining such therapies in acute or critical situations (such as severe COVID-19) was not recommended because they will take time to become effective, due to slow uptitration, and might provoke nausea and vomiting (Nauck and Meier, 2019).…”

Dissecting the interaction between COVID‐19 and diabetes mellitus

“…GLP-1 receptor agonist treatment in mice infected with respiratory syncytial virus is associated with a significant reduction in inflammatory cytokine production and attenuation of inflammation in the respiratory epithelium 39 . Furthermore, GLP-1 receptor agonist therapy in the intensive care unit setting is associated with a reduction of hypoglycemia, glucose variability and catabolism by suppressing glucagon 40 , all of which can be protective in these critically ill patients. However, delayed gastric emptying, which is common in the critically ill, might affect the extent of the benefits of glycemic control.…”

Therapy of Type 2 Diabetes in Patients with SARS-CoV-2 Infection

“…Because of the advantageous effects of GLP1RA treatment, such as a reduction in cardiovascular events [ 73 ], the prevention of cardiovascular disease and kidney disease [ 87 , 88 ], lowering body mass, as well as a reduction of the risk of hypoglycaemia and glucose variability in the setting of the intensive care unit [ 89 ], these drugs seem to be a good choice for patients who are at risk of a severe course of COVID-19. However, the initiation of such therapies is not recommended during acute or critical conditions because of the fact that GLP1RAs show a delayed onset of action and might cause nausea or vomiting at the beginning of treatment [ 90 ].…”