examination of the effects of liraglutide on diabetic nephropathy

Liraglutide (Lira), a glucagon-like peptide-1 receptor agonist, can be administered to diabetic patients with renal failure without dose reduction, but experience with the use of Lira in these patients is limited. This study was designed to examine the effects of 6-month Lira administration on glucose metabolism, body mass index (BMI), and renal function in 18 patients with diabetic nephropathy (eGFR <60 ml/min). The study included 18 patients with diabetic nephropathy who were on insulin/oral hypoglycemic medications (6 men, 12 women; average age, 60 years; HbA1c, 8.4%; BMI, 29.4 ± 8.2; duration of diabetes, 12 years; eGFR, 55.2 ± 6.3 ml/min/1.73 m2). Lira was given either in combination or as monotherapy. After 6 months of Lira treatment, changes in HbA1c levels, casual blood glucose levels, BMI, and eGFR were examined. The average HbA1c and casual blood glucose levels were significantly decreased after 6-month Lira administration (HbA1c before administration 8.4%, 7.9% at Month 1, 7.4% at Month 2, 7.1% at Month 3, 7.1% at Month 6; p < 0.01 respectively, Paired T test). There were, however, no significant changes in renal function. In conclusion, these results suggest that the administration of Lira in patients with diabetic nephropathy may improve glucose metabolism and reduce BMI without affecting renal function or albuminuria in the short term

Factors Associated with Changes in Brain Atrophy during a Three-Year Observation in Elderly Diabetic Patients: Effect of Renal Impairment on Hippocampal Atrophy

Background/Aims: We conducted a 3-year longitudinal study concerning factors associated with changes in brain atrophy in elderly diabetic patients. Methods: We evaluated hippocampal and global brain atrophy using automatic voxel-based morphometry of structural magnetic resonance images, 4 cognitive function tests, and cerebral small vessel disease (SVD) in 66 diabetic patients. Results: During the 3-year follow-up, hippocampal and global brain atrophy advanced, and cognitive functions worsened. For changes in hippocampal atrophy, changes in estimated glomerular filtration rate (eGFR), albuminuria, and being an ApoE ε4 carrier were independent factors; change in the number of silent brain infarctions was an independent factor for changes in global brain atrophy. A significant association of changes in eGFR and albuminuria with hippocampal atrophy remained after adjusting for confounders including SVD. Both types of brain atrophy at baseline were significantly correlated with cognitive impairment at baseline and especially associated with changes in delayed word recall during the follow-up after adjusting for confounders. Conclusion: Changes in eGFR and albuminuria during follow-up were independent risk factors for hippocampal atrophy, which was associated with decline in delayed word recall, suggesting that management of chronic kidney disease may prevent the progression of hippocampal atrophy