The role of glucagon-like peptide-1/GLP-1R and autophagy in diabetic cardiovascular disease
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Updated: Jun 23, 2025

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Published on: April 18, 2025
1Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06510, USA. zi.guo@yale.edu.
Insights
Diabetes accelerates vascular complications by damaging endothelial cells. Glucagon-like peptide (GLP)-1 analogs and autophagy modulation show promise for treating diabetic vascular disease.
Area of Science:
- Cardiovascular Biology
- Metabolic Diseases
- Cellular Homeostasis
Background:
- Diabetes mellitus significantly increases macrovascular and microvascular complications.
- Endothelial dysfunction is an early pathogenic event in diabetes-related vascular disease.
- Understanding molecular mechanisms is crucial for developing effective therapies.
Purpose of the Study:
- To review the role of the glucagon-like peptide (GLP)-1/GLP-1 receptor (GLP-1R) system in diabetic endothelial dysfunction.
- To explore the involvement of autophagy in the pathogenesis of diabetic vascular complications.
- To highlight the potential therapeutic crosstalk between autophagy and the GLP-1/GLP-1R axis.
Main Methods:
- Literature review focusing on molecular mechanisms.
- Analysis of studies on GLP-1/GLP-1R signaling in endothelial cells.
- Examination of research on autophagy's role in diabetic vascular pathology.
Main Results:
- The GLP-1/GLP-1R system is implicated in mitigating diabetic endothelial dysfunction.
- Autophagy plays a critical role in diabetes-induced vascular endothelium damage.
- A potential interplay exists between autophagy and the GLP-1/GLP-1R axis in managing diabetic angiopathy.
Conclusions:
- The GLP-1/GLP-1R axis and autophagy are key players in diabetic vascular complications.
- Targeting the crosstalk between autophagy and GLP-1/GLP-1R may offer novel therapeutic strategies for diabetic angiopathy.
Abstract:
Diabetes leads to a significantly accelerated incidence of various related macrovascular complications, including peripheral vascular disease and cardiovascular disease (the most common cause of mortality in diabetes), as well as microvascular complications such as kidney disease and retinopathy. Endothelial dysfunction is the main pathogenic event of diabetes-related vascular disease at the earliest stage of vascular injury. Understanding the molecular processes involved in the development of diabetes and its debilitating vascular complications might bring up more effective and specific clinical therapies. Long-acting glucagon-like peptide (GLP)-1 analogs are currently available in treating diabetes with widely established safety and extensively evaluated efficacy. In recent years, autophagy, as a critical lysosome-dependent self-degradative process to maintain homeostasis, has been shown to be involved in the vascular endothelium damage in diabetes. In this review, the GLP-1/GLP-1R system implicated in diabetic endothelial dysfunction and related autophagy mechanism underlying the pathogenesis of diabetic vascular complications are briefly presented. This review also highlights a possible crosstalk between autophagy and the GLP-1/GLP-1R axis in the treatment of diabetic angiopathy.
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