Dodamani MH, Hatwal J, Batta A. Role of intestinal glucagon-like peptide-1 in impaired counter-regulatory responses to hypoglycemia. World J Diabetes 2024; 15(12): 2394-2398 [DOI: 10.4239/wjd.v15.i12.2394]
Corresponding Author of This Article
Akash Batta, MD, Assistant Professor, Department of Cardiology, Dayanand Medical College and Hospital, Tagore Nagar, Civil Lines, Ludhiana 141001, Punjab, India. akashbatta02@gmail.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Manjunath Havalappa Dodamani, Department of Endocrinology, Rukmini Hormone Superspeciality Hospital, Bagalkot 587101, Karnātaka, India
Juniali Hatwal, Department of Internal Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh 160012, India
Akash Batta, Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Author contributions: Dodamani MH and Batta A designed the Editorial; Dodamani MH, Hatwal J, and Batta A performed the literature review and data collection; Dodamani MH and Batta A supervised the study and provided key feedback and suggestions; Dodamani MH analyzed the data, and wrote and revised the manuscript; All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
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: Akash Batta, MD, Assistant Professor, Department of Cardiology, Dayanand Medical College and Hospital, Tagore Nagar, Civil Lines, Ludhiana 141001, Punjab, India. akashbatta02@gmail.com
Received: July 28, 2024 Revised: October 8, 2024 Accepted: October 23, 2024 Published online: December 15, 2024 Processing time: 112 Days and 18.7 Hours
Abstract
Patients with type 1 diabetes mellitus (T1DM) experience multiple episodes of hypoglycemia, resulting in dysfunctional counter-regulatory responses with time. The recent experimental study by Jin et al explored the role of intestinal glucagon-like peptide-1 (GLP-1) in impaired counter-regulatory responses to hypoglycemia. They identified intestinal GLP-1 along with GLP-1 receptor (GLP-1R) as the new key players linked with impaired counter-regulatory responses to hypoglycemia in type 1 diabetic mice. They also demonstrated that excessive expression of GLP-1 and GLP-1R was associated with attenuated sympathoadrenal responses and decreased glucagon secretion. The study has enormous clinical relevance as defective counter regulation and hypoglycemia unawareness negatively impacts the intensive glycemic management approach in this group of patients. However, the physiological processes must be validated in dedicated human studies to comprehensively understand the pathophysiology of this complex relationship, and to clarify the true extent of impaired hypoglycemia counter regulation by intestinal GLP-1. For now, following the results of the index study and other similar studies, GLP-1 analogues usage in T1DM must be carefully monitored, as there is an inherent risk of worsening the already impaired counter-regulatory responses in these patients. Further studies in the future could identify other key players involved in this clinically relevant interaction.
Core Tip: Glucagon-like peptide-1 (GLP-1), an incretin hormone, plays an important role in blood glucose homeostasis, especially during the prandial phase. Excessive intestinal GLP-1 is correlated with reduced secretion of catecholamines and decreased appetite in type 1 diabetes mellitus mice exposed to recurrent hypoglycemic episodes resulting in impaired counter-regulatory responses to hypoglycemia. The index study of diabetic mice by Jin et al highlights the significant role of intestinal GLP-1 in impairment of hypoglycemia-induced counter-regulatory responses.
