Allostatic Load in Patients with Type 2 Diabetes Treated with GLP-1 Receptor Agonists

Abstract

Background:

In patients with type 2 diabetes (T2DM), glucagon-like peptide-1 (GLP-1) receptor agonists improve glycemic control and have been shown to enhance stress regulation, potentially attenuating the cumulative impact of chronic stress. Despite these links, few studies have examined allostatic load in patients with T2DM treated with GLP-1s.

Objectives:

To compare allostatic load among patients with T2DM treated with GLP-1s and three comparison groups: individuals without T2DM, individuals with T2DM not receiving medication treatment, and individuals with T2DM treated with non-GLP-1 medications.

Methods:

We analyzed data from 16,830 adults in the 2007–2018 National Health and Nutrition Examination Survey. Medication status was based on self-reported prescription use within the past month. Allostatic load was calculated primarily using a 13 biomarker index spanning metabolic, autonomic, and immune function and secondarily using a modified score that excluded HbA1c and insulin resistance. General linear regression was used to assess associations, adjusting for sociodemographics, comorbidities, and health behaviors.

Results:

Participants with T2DM treated with GLP-1s had higher allostatic load than those without T2DM (β = 1.57, 95% CI: 0.88, 2.25) but did not differ from participants with T2DM who were untreated or treated with non-GLP-1s. After excluding HbA1c and insulin resistance from the score, allostatic load in the GLP-1s-treated group was comparable across all comparison groups.

Conclusions:

GLP-1 treatment was not associated with lower allostatic load compared with other treatment regimens in patients with T2DM. Longitudinal studies with neuroendocrine measures are needed to better characterize its effects on stress regulation.