Chronic treatment with GLP-1 receptor agonists in patients with diabetes did not significantly alter the sympatho-vagal balance as measured by the LF/HF ratio (MD 0.18) compared to control.
Meta-Analysis (n=182)
Does chronic treatment with GLP-1 receptor agonists alter autonomic nervous system function in individuals with diabetes?
Chronic GLP-1R agonist treatment in diabetes increases heart rate but does not significantly alter sympatho-vagal balance as measured by LF/HF ratio.
Mean Difference: 0.18 (95% CI -0.66–1.01)
p-value: p=0.680
BACKGROUND: In addition to the metabolic effects in diabetes, glucagon-like peptide 1 receptor (GLP-1R) agonists lead to a small but substantial increase in heart rate (HR). However, the GLP-1R actions on the autonomic nervous system (ANS) in diabetes remain debated. Therefore, this meta-analysis evaluates the effect of GLP-1R agonist on measures of ANS function in diabetes. METHODS: According to the Cochrane Collaboration and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, we conducted a meta-analysis considering clinical trials in which the autonomic function was evaluated in diabetic subjects chronically treated with GLP-1R agonists. The outcomes were the change of ANS function measured by heart rate variability (HRV) and cardiac autonomic reflex tests (CARTs). RESULTS: In the studies enrolled, HR significantly increased after treatment (P<0.001), whereas low frequency/high frequency ratio did not differ (P=0.410); no changes in other measures of HRV were detected. Considering CARTs, only the 30:15 value derived from lying-to-standing test was significantly lower after treatment (P=0.002), but only two studies reported this measurement. No differences in other CARTs outcome were observed. CONCLUSION: The meta-analysis confirms the HR increase but seems to exclude an alteration of the sympatho-vagal balance due to chronic treatment with GLP-1R agonists in diabetes, considering the available measures of ANS function.
Greco et al. (2022) conducted a meta-analysis in Diabetes mellitus (Type 1 and Type 2) (n=182). GLP-1 receptor agonists vs. Control group (placebo or active comparator) was evaluated on Low frequency/high frequency (LF/HF) ratio after chronic GLP-1R agonist administration (MD 0.18, 95% CI -0.66 to 1.01, p=0.680). Chronic treatment with GLP-1 receptor agonists in patients with diabetes did not significantly alter the sympatho-vagal balance as measured by the LF/HF ratio (MD 0.18) compared to control.
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