Decreases in BMI, HbA1c with diabetes drugs can lower cardiometabolic disease risks
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Key takeaways:
- Treatment with diabetes medications can confer cardiometabolic benefits for adults with new-onset type 2 diabetes.
- Reductions in both BMI and HbA1c may reduce likelihood for needing insulin.
Decreases in body weight and HbA1c induced by GLP-1 receptor agonists and other diabetes drugs can reduce the risk for cardiometabolic complications for adults newly diagnosed with type 2 diabetes, researchers reported.
In findings published in Diabetes, Obesity and Metabolism, researchers assessed the risk for cardiometabolic complications among adults with type 2 diabetes using any one of six classes of diabetes medications and for those who only used a GLP-1 receptor agonist. BMI and HbA1c reductions were observed for both groups, and declines in both metrics reduced the risk for a variety of diabetes complications.
“Our analysis found that while some health outcomes improved predominantly due to weight reduction, others were more closely linked to better glycemic management,” Daniel Rotroff, PhD, MSPH, director of the Center for Quantitative Metabolic Research at Cleveland Clinic, told Healio. “These findings underscore the multifaceted benefits of GLP-1 therapies in real-world clinical settings and highlight the importance of addressing both weight management and hyperglycemia in patients with diabetes and obesity.”
Rotroff and colleagues conducted a retrospective study of adults newly diagnosed with type 2 diabetes who had data available in Cleveland Clinic’s electronic health records. Two groups of participants were assessed in the study. The first group included 8,876 adults with new-onset type 2 diabetes who used biguanides, sulfonylureas, GLP-1 receptor agonists, thiazolidinediones, SGLT2 inhibitors or DPP-IV inhibitors. The second group included 4,161 adults with type 2 diabetes who used a GLP-1. Researchers collected incidences of 19 clinical outcomes for adults using any diabetes drug and 11 outcomes for those using a GLP-1.
Benefits using any diabetes medication
During a median follow-up of 4.95 years, adults using any diabetes medication had a mean BMI decline of 2.01 kg/m2 and a mean HbA1c decrease of 0.39 percentage points.
Each 1 percentage point decrease in BMI at 1 year lowered the risk for essential hypertension (HR = 0.99; 95% CI, 0.98-1), dyslipidemia (HR = 0.98; 95% CI, 0.96-1), GERD (HR = 0.92; 95% CI, 0.83-0.99), osteoarthritis (HR = 0.98; 95% CI, 0.97-1), heart failure (HR = 0.97; 95% CI, 0.94-0.99) and musculoskeletal pain (HR = 0.93; 95% CI, 0.86-0.99).
Every 1 percentage point decrease in HbA1c at 1 year reduced the risk for essential hypertension (HR = 0.96; 95% CI, 0.92-0.99) and heart failure (HR = 0.87; 95% CI, 0.71-0.97).
Adults who maintained more than 5% weight loss over 1 year had a lower risk for metabolic dysfunction-associated steatohepatitis, formerly known as nonalcoholic steatohepatitis (HR = 0.76; 95% CI, 0.58-0.97) and musculoskeletal pain (HR = 0.45; 95% CI, 0.2-0.99).
The likelihood for starting insulin was reduced with each 1 percentage point decrease in BMI (HR = 0.96; 95% CI, 0.94-0.97) and HbA1c (HR = 0.71; 95% CI, 0.65-0.77).
GLP-1 use and clinical outcomes
During a median follow-up of 5.78 years, adults using a GLP-1 had a mean BMI decrease of 1.97 kg/m2 and a reduction in HbA1c of 0.29 percentage points.
Each 1 percentage point decline in BMI with GLP-1 use at 1 year reduced the risk for cardiovascular disease (HR = 0.96; 95% CI, 0.92-0.99) and osteoarthritis (HR = 0.96; 95% CI, 0.91-0.99).
Adults using a GLP-1 had a lower risk for chronic kidney disease (HR = 0.96; 95% CI, 0.93-0.98), but an increased risk for GERD (HR = 1.24; 95% CI, 1.09-1.36) with each 1 percentage point decrease in HbA1c at 1 year.
Adults who lost 5% or more of their body weight at 1 year had a lower risk for osteoarthritis (HR = 0.28; 95% CI, 0.15-0.55), CKD (HR = 0.28; 95% CI, 0.1-0.79) and essential hypertension (HR = 0.61; 95% CI, 0.22-0.98). Adults who maintained a durable HbA1c decrease at 1 year had a lower risk for developing essential hypertension (HR = 0.64; 95% CI, 0.43-0.93).
Adults using a GLP-1 were less likely to use insulin with each 1 percentage point decrease in BMI (HR = 0.97; 95% CI, 0.95-0.99) and HbA1c (HR = 0.84; 95% CI, 0.75-0.92).
“Several of these findings are quite compelling,” Rotroff said. “Notably, each 1 percentage point reduction in weight was associated with a 3% decrease in the likelihood of initiating insulin therapy, independent of glycemic improvements. This suggests that weight loss alone may confer additional benefits beyond glucose control.
“Moreover, the data indicate that the observed risk reduction for CKD in patients with type 2 diabetes was primarily linked to enhanced glycemic management, underscoring the critical role of blood sugar control in mitigating renal complications,” Rotroff said.
Rotroff also noted that individuals with type 2 diabetes can have widely varying responses to treatment and more research is needed to investigation the reasons behind that variation.
“Additionally, there is a critical need for predictive tools and biomarkers to help clinicians identify the most effective treatment for each patient, enabling more personalized and targeted health care,” Rotroff said.
For more information:
Daniel Rotroff, PhD, MSPH, can be reached at rotrofd@ccf.org.
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