GLP-1RA superior to basal insulin in control of total, LDL cholesterol
Glucagon-like peptide-1 receptor agonists (GLP-1RA) are more effective than basal insulin in the management of total (TC) and low-density lipoprotein cholesterol (LDL-C), reveals a recent study.
Additionally, basal insulin significantly lowers serum triglycerides, while thiazolidinedione is effective in improving high-density lipoprotein cholesterol (HDL-C). Dipeptidyl peptidase–4 inhibitors (DPP4-I) and standard therapy, on the other hand, demonstrate no significant impact on lipid levels.
A meta-analysis was conducted on randomized controlled trials that reported changes in lipid parameters in type 2 diabetes (T2D) patients who were randomly assigned to basal insulin or other classes of antihyperglycaemic agents.
Therapies with GLP-1RA were associated with significant reduction in the levels of TC and LDL-C as compared with basal insulin (mean difference [MD], –3.80 mg/dL, 95 percent confidence interval [CI], –6.30 to –1.30; p<0.001 and MD, –4.17 mg/dL, 95 percent CI, –6.04 to –2.30; p<0.0001). However, there was no difference between basal insulin and DPP4-I or standard therapy (sulfonylurea ± metformin).
Treatment with thiazolidinediones correlated with significant improvement in HDL-C (MD, 3.55 mg/dL, 95 percent CI, 0.55–6.56; p=0.02) but was also associated with an increase in TC and LDL-C (MD, 16.20 mg/dL, 95 percent CI, 9.09–23.31; p<0.001 and MD, 5.19 mg/dL, 95 percent CI, –3.00 to 13.39; p=0.21). In triglyceride reduction, basal insulin showed superiority to standard therapy (MD, 3.8 mg/dL, 95 percent CI, 0.99–6.63; p=0.008).
“The lipid profile represents a driver of cardiovascular risk in T2D,” the authors said.