Abstract Glucagon-Like Peptide-1 (GLP-1) and its analogues have therapeutic potential in treating various conditions like Type 2 diabetes (T2D) and obesity, with a focus on their neuroprotective and anti-inflammatory properties in ocular diseases. GLP-1, a hormone produced in the intestinal mucosa and brain, enhances insulin secretion and lowers blood glucose levels. GLP-1 receptor agonists (GLP-1RAs) are effective in treating T2D mellitus (T2DM) and obesity, and have shown potential in treating heart failure (preserved ejection fraction), diabetic kidney disease, and neurodegenerative diseases like Parkinson’s and Alzheimer’s. In ocular diseases, GLP-1RAs have demonstrated protective effects against diabetic retinopathy and glaucoma by reducing inflammation, preventing retinal cell loss, and maintaining vascular integrity. Semaglutide, a GLP-1RA, is used for T2DM and obesity treatment, showing significant weight reduction and glycemic control. This review aims to a deeper understanding of how GLP-1RAs, including semaglutide, offer promising therapeutic benefits for both metabolic and ocular health conditions.
Abstract Adiposity-Based Chronic Disease (ABCD) is a complex, multifactorial condition that recognizes obesity as a chronic, relapsing disease influenced by biological, behavioral, cultural, and environmental factors. The ABCD framework emphasizes a patient-centered, holistic approach to diagnosis and treatment, moving beyond weight-centric models to address the systemic consequences of adiposity. Among therapeutic options, GLP-1 receptor agonists (GLP-1RAs) have emerged as a cornerstone in the management of ABCD by improving metabolic parameters and targeting the underlying pathophysiology of multiple interrelated conditions. GLP-1RAs enhance glycemic control and insulin sensitivity in type 2 diabetes while promoting weight loss and reducing cardiovascular risk by lowering blood pressure, improving lipid profiles, and reducing inflammation. They have shown efficacy in treating heart failure with preserved ejection fraction (HFpEF), particularly in patients with obesity. In metabolic dysfunction-associated steatotic liver disease (MASLD), GLP-1RAs reduce hepatic steatosis and inflammation, while in polycystic ovary syndrome (PCOS), they improve ovulation and menstrual regularity. Additionally, GLP-1RAs support kidney function preservation in chronic kidney disease (CKD) through blood pressure and glucose regulation and anti-inflammatory effects. Hence, the pleiotropic benefits of GLP-1Ras extend across the eight ABCD pillars obesity, type 2 diabetes, cardiovascular disease/heart failure, MASLD, polycystic ovary syndrome/infertility, CKD, hypertension, and dyslipidaemia positioning GLP-1RAs as a versatile, disease-modifying therapy. Also, the availability of oral semaglutide has further enhanced accessibility and convenience in the long-term management of ABCD, especially for patients preferring non-injectable therapies. In this clinical review, we will discuss the therapeutic role of GLP-1RAs, with a focus on oral semaglutide, across the eight pillars of ABCD, highlighting their multisystem benefits beyond weight loss.
AbstractThis retrospective observational study, building on prior research that demonstrated the efficacy of the Digital Twin (DT) Precision Treatment Program over shorter follow-up periods, aimed to examine glycemic control and reduced anti-diabetic medication use after one-year in a DT commercial program. T2D patients enrolled had adequate hepatic and renal function and no recent cardiovascular events. DT intervention powered by artificial intelligence utilizes precision nutrition, activity, sleep, and deep breathing exercises. Outcome measures included HbA1c change, medication reduction, anthropometrics, insulin markers, and continuous glucose monitoring (CGM) metrics. Of 1985 enrollees, 132 (6.6%) were lost to follow-up, leaving 1853 participants who completed one-year. At one-year, participants exhibited significant reductions in HbA1c [mean change: -1.8% (SD 1.7%), p < 0.001], with 1650 (89.0%) achieving HbA1c below 7%. At baseline, participants were on mean 1.9 (SD 1.4) anti-diabetic medications, which decreased to 0.5 (SD 0.7) at one-year [change: -1.5 (SD 1.3), p < 0.001]. Significant reductions in weight [mean change: -4.8 kg (SD 6.0 kg), p < 0.001], insulin resistance [HOMA2-IR: -0.1 (SD 1.2), p < 0.001], and improvements in β-cell function [HOMA2-B: +21.6 (SD 47.7), p < 0.001] were observed, along with better CGM metrics. These findings suggest that DT intervention could play a vital role in the future of T2D care.
Background: An early initiation of statins in the diabetes population helps in prevention of atherosclerotic cardiovascular disease (ASCVD). However, there is a paucity of data on its use in young Indian patients with diabetes. This survey report aimed to provide opinion-based recommendations for pragmatic usage of statin in diabetes population of India. Material and Methods: Discussion and virtual survey (a questionnaire of 18 questions) was conducted at 16 round table meetings (RTMs) which included participation of health-care practitioners (HCPs) from India. On the basis of their opinions and discussion, general recommendations about early usage of statins in diabetes for prevention of ASCVD were derived. Results: Out of 261 HCPs participated, 56.1% recommended initiating statins in patients aged 41–50 years irrespective of their total/low-density lipoprotein cholesterol (LDL-C) levels. Among people with diabetes aged between 20 and 39 years, 38.9% of HCPs considered LDL-C >100 mg/dL and 77% of HCPs considered history of ASCVD as a risk factor for early statin initiation. Overall, 98.9% of HCPs agreed that early initiation of statin in people with diabetes and ASCVD risk factors will help reduce ASCVD. The majority of HCPs recommended initiating moderate-intensity (51.2%) and low-intensity (43.8%) statins and assess every 3 months for tolerance and compliance in people with diabetes (aged 20–39 years) and additional ASCVD risk factors. The use of rosuvastatin (78.5% of HCPs) was preferred for early initiation in people with diabetes. Majority of HCPs agreed (57.3%) or strongly agreed (36.2%) that rosuvastatin has more clinical utility compared to other statins due to better LDL-C-lowering effect and other pleiotropic effects. Physician's inertia limits the effective use of statins among young adults with diabetes (55.8%), and 65.8% of HCPs recommended screening of people with diabetes for additional ASCVD risk factors. Conclusion: The participating HCPs opined that early initiation of statin therapy in people with diabetes and ASCVD risk factors will help reduce ASCVD. Rosuvastatin is mostly recommended for early initiation of statin therapy among the diabetes population for prevention of ASCVD. There is a necessity of using a proactive approach to screen for additional ASCVD risk factors in young individuals with diabetes and further increase the awareness about benefits of initiating statin therapy from an early stage.
