Understanding the Benefit of Combining GLP-1 Agonists With Exercise: Time Will Tell
Year: 2023
Type: editorial
Abstract: Exercise improves blood glucose control among people with type 2 diabetes (T2D), and can lead to reduced need for glucose medications (1, 2). Although the optimal exercise “dose” (eg, intensity, modality, time of day, and/or duration) remains to be determined, it is appropriate to recognize that the improvements seen across people vary—with some experiencing little benefit to even slight rises (2). Subsequently, pharmacological agents are likely needed for some people to manage blood glucose to prevent/attenuate macrovascular and microvascular complications associated with the disease. Much attention over the past decade has focused on understanding how metformin, the first-line agent for treatment of hyperglycemia, interacts with exercise (3). In recent years, interest in other glucose medications in combination with exercise have been investigated. Glucagon-like peptide-1 (GLP-1) agonists are both effective glycemic agents and potent weight loss therapy aids. In fact, there has been much excitement for GLP-1 agonists, namely semaglutide relative to others (eg, liraglutide), regarding weight loss (4). Novel work (5) presented in the Journal of Clinical Endocrinology & Metabolism demonstrates that the combination of semaglutide plus aerobic training improved beta-cell insulin secretion function more than training alone as evaluated by a 2-stepped hyperglycemic (20 and 20 mM) clamp in people with T2D. Interestingly, these findings were supported by use of an oral glucose tolerance test, whereby beta-cell glucose sensitivity was improved independent of circulating GLP-1 or total glucose-dependent insulinotropic polypeptide (GIP). Of note, patients were allocated to semaglutide for 20 weeks prior to training and then evaluated before and after aerobic training. Aerobic exercise consisted of cycling 3 days/week at 75% of maximum heart rate reserve for 45 minutes/session for 12 weeks. Semaglutide was administered once weekly by subcutaneous injection and ramped up over 8 weeks until 0.5 mg or 1.0 mg was achieved by week 9 and ensued for the remainder of the study. Treatment with semaglutide significantly reduced HbA1c and fasting glucose as well as visceral fat and total body fat before training commenced. However, after commencement of exercise, training with or without semaglutide improved glycemic control and body composition comparably.
Author: Steven K Malin
Institution: Rutgers, The State University of New Jersey
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4385245367