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Several in vitro and in vivo results have expanded the role of these molecules from potentiating glucose-stimulated insulin secretion to promoting -cell survival under different stressful environments by favoring proliferation, neogenesis and resistance to apoptosis ( via secretion of IGF-2 from the same cells ( In agreement with experimental studies, GLP-1 analogues, particularly liraglutide, sustain the maintenance of -cell function in obese individuals with early T2D, and these effects are presumably independent of weight loss ( Further, experimental data suggest that the pro-survival action of GLP-1RAs may also be mediated by the Akt-dependent stimulation of the mTORC1/S6K1 pathway, the activation of which is dependent upon the IGF-1R, as observed in rodent islet cells ( in vitro , exendin-4 lost the ability to activate this pathway, suggesting that GLP-1 analogues may restore -cell proliferation via autocrine or paracrine activation of IGF-1R ( In concert, these results define a new scenario of action for incretin-based therapy that may involve the adipo-insular axis, linking the weight lowering competence with the sustained protection of -cells from diabetogenic stressors
We don't have robust long-term data on: What happens to muscle mass and bone density over 5-10 years of use The impact on people who start these medications in their 20s or 30s Impact on fertility/reproductive outcomes Early data is showing that GLP-1 might help in PCOS, but what about long-term hormonal regulation
1 2 The Gila Monster and its allies: the relationships, habits, and behavior of the lizards of the Family Helodermatidae
