title: Baseline ALT levels as a marker of glycemic response to treatment with GLP-1 receptor agonists.
abstract: OBJECTIVE
  This study aimed to assess if ALT levels, as a marker of non-alcoholic fatty liver disease, may predict HbA1c response to treatment with GLP-1 receptor agonists (GLP-1 RAs).
  
  
  METHODS
  A retrospective, longitudinal, analytical study was conducted including patients with type 2 diabetes mellitus continuously treated with GLP-1 agonists (85% with liraglutide) for one year. Patients were divided into two groups according to baseline ALT levels, with 24 U/L (the median of the distribution) as the cut-off point. The dependent variable was HbA1c change (one-year follow-up minus baseline). The predictive value of ALT levels above 24 U/L and ALT change was analyzed using multivariate linear regression adjusted to age, gender, diabetes duration, type and dose of GLP-1 RA, baseline HbA1c, baseline body mass index (BMI), and change in BMI.
  
  
  RESULTS
  A total of 117 patients (48% females) aged 58.6 (SD 9.6) years were enrolled into the study. Treatment was associated with a change in ALT of -4.3 U/L (p=0.041) and a change in HbA1c of -1.1% (p<0.0001). Decreases in HbA1c (-1.41% vs -0.76%; p=0.045) and ALT (-9.25 vs 0.46 U/L; p=0.002) were significantly higher in patients with ALT levels above the median. In the multivariate analysis, both ALT>24 U/L (b=-0.74; 95%CI: -1.31 to -0.18; p=0.011) and ALT change (b=0.028; 95%CI: 0.010 to 0.046; p=0.003), were significant response predictors.
  
  
  CONCLUSIONS
  Elevated baseline transaminase values and decreased transaminase levels during follow-up are associated to a favorable glycemic response to GLP-1 RAs.
authors.affiliation: Hospital Clínico Universitario Lozano Blesa, Zaragoza, España. Electronic address: jagimeno@salud.aragon.es.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Gimeno-Orna
authors.affiliation: Hospital Universitario Miguel Servet, Zaragoza, España.
authors.forename: Guayente
authors.initials: G
authors.lastname: Verdes-Sanz
authors.affiliation: Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
authors.forename: Laura
authors.initials: L
authors.lastname: Borau-Maorad
authors.affiliation: Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
authors.forename: Julia
authors.initials: J
authors.lastname: Campos-Fernández
authors.affiliation: Hospital Universitario Miguel Servet, Zaragoza, España.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Lardiés-Sánchez
authors.affiliation: Hospital Universitario Miguel Servet, Zaragoza, España.
authors.forename: Marta
authors.initials: M
authors.lastname: Monreal-Villanueva
mesh_terms: D001786:Blood Glucose; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000637:Transaminases / Q000097:blood*; D000097789:Glucagon-Like Peptide-1 Receptor Agonists
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D000637:Transaminases; D000097789:Glucagon-Like Peptide-1 Receptor Agonists
keywords: Agonistas del receptor de GLP1; Diabetes tipo 2; Esteatosis hepática no alcohólica; GLP-1 receptor agonists; Non-alcoholic fatty liver disease; Type 2 diabetes mellitus