Glucagon-like peptide-1 receptor agonists reverse nerve morphological abnormalities in diabetic peripheral neuropathy

Aims/hypothesis Diabetic peripheral neuropathy (DPN) is a highly prevalent cause of physical disability. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are used to treat type 2 diabetes and animal studies have shown that glucagon-like peptide-1 (GLP-1) receptors are present in the central and peripheral nervous systems. This study investigated whether GLP-1 RAs can improve nerve structure. Methods Nerve structure was assessed using peripheral nerve ultrasonography and measurement of tibial nerve cross-sectional area, in conjunction with validated neuropathy symptom scores and nerve conduction studies. A total of 22 consecutively recruited participants with type 2 diabetes were assessed before and 1 month after commencing GLP-1 RA therapy (semaglutide or dulaglutide). Results There was a pathological increase in nerve size before treatment in 81.8% of the cohort ( n =22). At 1 month of follow-up, there was an improvement in nerve size in 86% of participants ( p <0.05), with 32% returning to normal nerve morphology. A 3 month follow-up study ( n =14) demonstrated further improvement in nerve size in 93% of participants, accompanied by reduced severity of neuropathy ( p <0.05) and improved sural sensory nerve conduction amplitude ( p <0.05). Conclusions/interpretation This study demonstrates the efficacy of GLP-1 RAs in improving neuropathy outcomes, evidenced by improvements in mainly structural and morphological measures and supported by electrophysiological and clinical endpoints. Future studies, incorporating quantitative sensory testing and measurement of intraepidermal nerve fibre density, are needed to investigate the benefits for small fibre function and structure. Graphical Abstract