The study of more than two million veterans with diabetes details GLP-1 RA use relating to 175 outcomes; without randomization, caution urged in interpretation.
A study of more than two million people with diabetes builds on evidence of broad-ranging benefits and risks of glucagon-like peptide 1 receptor agonists in the clinical setting, providing an “atlas” mapping extensive outcomes and some new insights to potentially explore in more rigorous clinical trials.
The study also included a composite group of the latter three drug groups , and a control group of 1,203,097 of patients receiving usual care, who were compared with usual care with the addition of GLP-1 RAs. Of the various benefits, key improvements included a reduced risk for several substance use disorders including alcohol and opioid use, suicidal ideation, attempt or intentional self-harm , seizures , neurocognitive disorders including Alzheimer’s disease and dementia , coagulation and clotting disorders , and cardiac arrest .
The reductions in suicidal ideation are encouraging after earlier reports of suicidal thoughts and self-injury among young users of GLP-1 RAs prompted concerns, including a 2023 review of the drug use by the European Medicines Agency that ultimately found no causal association, the authors added. The US Food and Drug Administration also found
“GLP-1 RAs should be further evaluated in future studies as potential adjuvant therapeutics for epilepsy and its associated comorbidities,” the authors suggested.While the findings support evidence of protective effects of GLP-1 RAs on the kidneys and a reduction in CKD risk, notable risks observed, also involving the kidneys, include nephrolithiasis or kidney stones.
“This may also imply that these drugs are most beneficial when used in conjunction with other interventions, such as lifestyle changes or other medications.”Commenting on the study, David M. Nathan, MD, founder of the MGH Diabetes Center and a professor of medicine at Harvard Medical School, in Boston, Massachusetts, noted that, while the study is hypothesis-generating, the key limitation is its observational nature.
Diabetes Mellitus Type Ii Type 2 Diabetes Type 2 DM T2DM T2D Renal Failure Renal Insufficiency Kidney Insufficiency Kidney Failure Renal Impairment Chronic Renal Failure Chronic Kidney Failure Chronic Kidney Disease CKD Chronic Kidney Disease (CKD) Kidney Stones Nephrolithiasis Renal Calculus Renal Calculi Kidneys Acute Kidney Injury AKI
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