Clinical Trials Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Mar 15, 2023; 14(3): 279-289
Published online Mar 15, 2023. doi: 10.4239/wjd.v14.i3.279
Postprandial glucagon-like peptide 1 secretion is associated with urinary albumin excretion in newly diagnosed type 2 diabetes patients
Lu-Lu Song, Na Wang, Jin-Ping Zhang, Li-Ping Yu, Xiao-Ping Chen, Bo Zhang, Wen-Ying Yang
Lu-Lu Song, Na Wang, Jin-Ping Zhang, Li-Ping Yu, Xiao-Ping Chen, Bo Zhang, Wen-Ying Yang, Department of Endocrinology, China-Japan Friendship Hospital, Beijing 100029, China
Author contributions: Song LL analyzed the data the data and drafted the manuscript; Zhang JP and Wang N collected the data and performed the literature review; Yu LP provides ideas and commentary in the process of writing the article; Chen XP and Zhang B coordinated the implementation of the study; Yang WY was the principal investigator of the study; and all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved China-Japan Friendship Hospital Institutional Review Board (Approval No. 2008-23).
Clinical trial registration statement: This trial was registered at ChiCTR (registration: No. ChiCTR-TRC-08000231).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Ying Yang, MD, Professor, Department of Endocrinology, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing 100029, China, ywy_1010@163.com
Received: October 27, 2022
Peer-review started: October 27, 2022
First decision: December 12, 2022
Revised: December 21, 2022
Accepted: February 16, 2023
Article in press: February 16, 2023
Published online: March 15, 2023
ARTICLE HIGHLIGHTS
Research background

The increase in urinary albumin excretion appeared in the early stage of type 2 diabetes mellitus (T2DM) independent of blood glucose and diabetic duration, which suggests that there may be other mechanisms involved in glomerular basement membrane damage during the progression of abnormal glucose metabolism. Identifying related factors and understanding the underlying mechanisms are helpful for the prevention of diabetic nephropathy.

Research motivation

Metabolic hormones have been confirmed to play an important role in the development of diabetes. Evidence that metabolic hormones also have renoprotective effects is needed to develop prevention measures.

Research objectives

This research intends to find the relationship between glucagon-like peptide 1 (GLP-1) secretion and microalbuminuria in untreated new type 2 diabetes patients.

Research methods

Newly diagnosed T2DM patients were recruited for this cross-sectional study. The urinary albumin-creatinine ratio (UACR) and active GLP-1 levels at 0 min, 30 min, 120 min and 180 min during a standard meal test were determined. We used multivariable linear regression analyses to detect the mean differences [B; 95% confidence interval (CI)] in LnUACR between patients with different quartiles of postprandial plasma GLP-1 levels, with the first quartile (Q1) set as the reference, to display the degree of influence of post plasma GLP-1 secretion on UACR. Multivariate logistic regression analyses were performed to analyze the impact of postprandial GLP-1 levels on the risk of microalbuminuria, which is shown as the odds rations (95%CIs) for microalbuminuria in different postprandial GLP-1 levels.

Research results

Ln30 min GLP-1, Ln120 min GLP-1 and the corresponding Ln [area under the curve for active GLP-1 (AUCGLP-1)] were negatively correlated with natural logarithm of UACR . The UACR of the patients in Q4 of postprandial GLP-1 levels was significantly higher than the UACR of the patients in Q1. The prevalence of microalbuminuria decreased with increasing quartiles of 30 min and 120 min and AUCGLP-1 levels. Logistic regression analysis revealed that after adjustment for other confounders, patients in Q4 of postprandial GLP-1 levels exhibited a decreased risk of microalbuminuria compared with those in Q1 by up to approximately 50%. The adjusted microalbuminuria risk for patients from Q4 of AUCGLP-1 levels was 0.547-fold (95%CI: 0.325 to 0.920).

Research conclusions

Our study showed for the first time that higher postprandial GLP-1 levels after a standard meal were negatively associated with microalbuminuria in newly diagnosed T2DM patients independent of metabolic status. This finding adds clinical evidence for the renoprotective effect of GLP-1 in newly diagnosed T2DM patients.

Research perspectives

Prospective studies should clarify the effect of measures that increase postprandial GLP-1 levels, including dietary strategies involving adjusting diet structure and meal sequence, on preventing and alleviating diabetic nephropathy in the early stage of diabetes.