Date of Graduation

Summer 8-10-2013

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Davis-Risen Saje

Second Advisor

Annjanette Sommers, PA-C, MS

Abstract

Background: Congestive heart failure (CHF) and diabetes mellitus are serious and chronic complex diseases that commonly coexist together. The pathophysiology of the link between congestive heart failure and diabetes is impaired glucose homeostasis that affects the myocardium at both the cellular and structural level that eventually affects its intrinsic biochemical pathway leading to progression of the failing heart. The aim of this study was to attempt to clarify whether glucagon-like peptide (GLP-1) infusions improve cardiac function in congestive heart failure patients.

Methods: An exhaustive search of Medline-OVID, CINAHL, Medline-PubMed and Google Scholar using the keywords: congestive heart failure, insulin resistance, diabetes, metabolism, GLP-1, exenatide, liraglutide, and left ventricular function.

Relevant articles were assessed for quality using GRADE.

Results: Three studies met inclusion criteria and were included in this systematic review. A non-randomized pilot study of 21 CHF patients with and without diabetes with 5 weeks of GLP-1 infusion that demonstrated improved left ventricular ejection fraction (LVEF) and quality of life (QOL). A double-blind, randomized, two-period cross-over trial of 20 CHF patients with diabetes with 6 hours of GLP-1 infusion followed by a wash out period illustrated improved cardiac function (cardiac index, PCWP, RAP). The final study was a non-randomized pilot study of 6 patients with diabetes with 3 days of GLP-1 infusion that showed improved global systolic and diastolic function.

Conclusion: The above clinical studies have provided a promising impact in the improvement of cardiac function in a failing heart. However, these studies lack randomization and are of a small sample size. Therefore, further intense research studies are necessary to confirm these initial observations and to investigate the underlying mechanisms and explore possible interactions with the current heart failure therapies. At this point, the role of GLP-1 in reversing the cardiac function in the failing heart are still at its infancy, thus more clinical trials with stronger patient important outcomes in regards to cardiovascular morbidity and mortality as needed

Keywords: congestive heart failure, insulin resistance, diabetes, metabolism, GLP-1, exenatide, liraglutide and left ventricular function

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