Impact cardiovasculaire des incrétino-mimétiques chez le diabétique de type 2 : le point en 2015

Les incrétino-mimétiques (agonistes du récepteur du glucagon-like peptide-1 [GLP-1] et inhibiteurs de la dipeptidylpeptidase IV [DPP-4]) occupent aujourd’hui une place importante dans la stratégie de traitement du diabète de type 2 (DT2). Sachant le risque élevé de complications cardiovasculaires dans le DT2, il est essentiel pour les cliniciens de s’assurer de la sécurité cardiovasculaire de ces deux nouvelles classes de médicaments. Le but de cet article est de proposer, sur base d’une revue exhaustive de la littérature, un état des lieux des effets cardiovasculaires des agonistes du récepteur du GLP-1 et des inhibiteurs de la DPP-4. À ce stade de nos connaissances, la littérature scientifique suggère, globalement, une sécurité cardiovasculaire. Cela étant, les études à long terme devront le confirmer et, en particulier, préciser le risque éventuel de décompensation cardiaque sous inhibiteurs de la DPP-4.[Collateral cardiovascular effects of incretinomimetics in patients with type 2 diabetes: State of the art in 2015] Incretinomimetics (GLP-1 receptor agonists and DPP-4 inhibitors) are nowadays an important therapeutic approach in patients with type 2 diabetes (T2D). In view of the increased risk of cardiovascular morbimortality in T2D, it is essential for clinicians to evaluate the safety of these new drugs in this field. The aim of this paper is to review, on the basis of recent scientific literature, cardiovascular effects of GLP-1 receptor agonists and DPP-4 inhibitors. Up to now, experimental and clinical studies suggest rather a cardiovascular safety of these drugs. However, long term well designed studies should confirm this particular aspect and in particular precise if DPP-4 inhibitors are associated or not with an increased risk of congestive heart failure

An elevated 1-h post- load glucose level during the oral glucose tolerance test detects prediabetes.

The objective of the study was to compare the diagnosis of dysglycemic states by conventional oral glucose tolerance test (OGTT) criteria (fasting and 2-h plasma glucose) with the 1-h post-load plasma glucose level. 34 individuals (mean age: 55±13years; BMI: 27.7±6.3kg/m) at risk for prediabetes were administered a 75g OGTT. Individuals with normal glucose tolerance (NGT) or prediabetes were identified according to fasting and/or 2-h plasma glucose (PG) concentrations. Subsequently, subjects were divided in 2 groups: group 1 (n=21) with a 1-h PG<155mg/dl and group 2 (n=13) with a 1-h PG≥155mg/dl. HOMA was performed to assess β-cell function and insulin sensitivity. NGT or prediabetes based on conventional criteria correlated with the 1-h PG<or≥155mg/dl (p<0.001). Moreover, the 1-h PG≥155mg/dl was associated with higher HbA levels (6.1±0.5 vs. 5.5±0.3%, p<0.001) and significantly impaired insulin secretion and hyperbolic product (BxS) on HOMA test vs. 1-h PG<155mg/dl. The 1-h post-load plasma glucose value ≥155mg/dl is strongly associated with conventional criteria for (pre)diabetes and alterations of β-cell function