Abstract
Background: Inflammation plays an important role in the pathogenesis of type 2 diabetes mellitus (T2DM) and the development of complications. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used to treat T2DM. Mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are simple biomarkers of inflammation. This study evaluated the effects of six-month exenatide therapy on these parameters.
Methods: This single-center retrospective cohort study evaluated 100 adult patients with type 2 diabetes who initiated exenatide treatment and maintained a stable baseline treatment regimen for 6 months (no medication changes for at least 6 months). Clinical, biochemical, and blood count parameters were compared at the start of treatment (month 0) and at months 3 and 6.
Results: At the start of treatment, patients' weight decreased from 111.1±24.4 kg to 104.7±20.8 kg after 6 months (p<0.001). Initial HbA1c values decreased from 68.6±20.3 mmol/mol (8.43±1.86%) to 60.9±16.1 mmol/mol (7.72±1.47%) at 6 months (p<0.001). NLR remained unchanged throughout the study, while PLR showed a transient increase at 3 months (p=0.03) but returned to baseline at 6 months. Furthermore, ALT values were significantly lower at 6 months compared to baseline (p=0.048).
Conclusions: These findings suggest that exenatide therapy may be associated with improvements in metabolic parameters and a modest reduction in MPV. However, given the retrospective design and the lack of direct assessment of treatment adherence and persistence, these results should be interpreted with caution.
References
1. Aktas G. Exploring the link: Hemogram-derived markers in type 2 diabetes mellitus and its complications. World J Diabetes. 2025: 105233 [PMID: 40697587, https://doi.org/10.4239/wjd.v16.i7.105233]
2. Aktas G, Yilmaz S, Kantarci DB, Duman TT, Bilgin S, Balci SB, Atak Tel BM. Is serum uric acid-to-HDL cholesterol ratio elevation associated with diabetic kidney injury? Postgrad Med. 2023: 519 [PMID: 37170820, https://doi.org/10.1080/00325481.2023.2214058]
3. Bonfioli GB, Rodella L, Metra M, Vizzardi E. GLP-1 receptor agonists as promising anti-inflammatory agents in heart failure with preserved ejection fraction. Heart Fail Rev. 2025: 131 [PMID: 39425816, https://doi.org/10.1007/s10741-024-10450-6]
4. Aktas G, Atak Tel BM, Tel R, Balci B. Treatment of type 2 diabetes patients with heart conditions. Expert Rev Endocrinol Metab. 2023: 255 [PMID: 37078758, https://doi.org/10.1080/17446651.2023.2204941]
5. Buse Balci S, Aktas G. A Comprehensive Review of the Role of Hemogram Derived Inflammatory Markers in Gastrointestinal Conditions. Iranian Journal of Colorectal Research. 2022: 75 https://doi.org/10.30476/acrr.2022.97244.1160]
6. Kocak MZ, Aktas G, Erkus E, Duman TT, Atak BM, Savli H. Mean Platelet Volume to Lymphocyte Ratio as a Novel Marker for Diabetic Nephropathy. J Coll Physicians Surg Pak. 2018: 844 [PMID: 30369376, https://doi.org/10.29271/jcpsp.2018.11.844]
7. Basaran E, Aktas G. The relationship of vitamin D levels with hemogram indices and metabolic parameters in patients with type 2 diabetes mellitus. AIMS Medical Science. 2024: 47 https://doi.org/10.3934/medsci.2024004]
8. Zhang T, Perkins MH, Chang H, Han W, de Araujo IE. An inter-organ neural circuit for appetite suppression. Cell. 2022: 2478 [PMID: 35662413, https://doi.org/10.1016/j.cell.2022.05.007]
9. Zheng Z, Zong Y, Ma Y, Tian Y, Pang Y, Zhang C, Gao J. Glucagon-like peptide-1 receptor: mechanisms and advances in therapy. Signal Transduct Target Ther. 2024: 234 [PMID: 39289339, https://doi.org/10.1038/s41392-024-01931-z]
10. Nauck MA, Meier JJ. MANAGEMENT OF ENDOCRINE DISEASE: Are all GLP-1 agonists equal in the treatment of type 2 diabetes? Eur J Endocrinol. 2019: R211 [PMID: 31600725, https://doi.org/10.1530/EJE-19-0566]
11. Nauck MA, Quast DR, Wefers J, Meier JJ. GLP-1 receptor agonists in the treatment of type 2 diabetes - state-of-the-art. Mol Metab. 2021: 101102 [PMID: 33068776, https://doi.org/10.1016/j.molmet.2020.101102]
12. Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B, Mohler ER, Reilly MP, Berger JS. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis. J Thromb Haemost. 2010: 148 [PMID: 19691485, https://doi.org/10.1111/j.1538-7836.2009.03584.x]
13. Cameron-Vendrig A, Reheman A, Siraj MA, Xu XR, Wang Y, Lei X, Afroze T, Shikatani E, El-Mounayri O, Noyan H, Weissleder R, Ni H, Husain M. Glucagon-Like Peptide 1 Receptor Activation Attenuates Platelet Aggregation and Thrombosis. Diabetes. 2016: 1714 [PMID: 26936963, https://doi.org/10.2337/db15-1141]
14. Korniluk A, Koper-Lenkiewicz OM, Kaminska J, Kemona H, Dymicka-Piekarska V. Mean Platelet Volume (MPV): New Perspectives for an Old Marker in the Course and Prognosis of Inflammatory Conditions. Mediators Inflamm. 2019: 9213074 [PMID: 31148950, https://doi.org/10.1155/2019/9213074]
15. Ren Y, Chen Y, Zheng W, Kong W, Liao Y, Zhang J, Wang M, Zeng T. The effect of GLP-1 receptor agonists on circulating inflammatory markers in type 2 diabetes patients: A systematic review and meta-analysis. Diabetes Obes Metab. 2025: 3607 [PMID: 40230207, https://doi.org/10.1111/dom.16366]
16. Karagoz I, Aktas G, Yoldas H, Yildiz I, Ogun MN, Bilgi M, Demirhan A. Association Between Hemogram Parameters and Survival of Critically Ill Patients. J Intensive Care Med. 2019: 511 [PMID: 28385106, https://doi.org/10.1177/0885066617703348]
17. Posul E, Yilmaz B, Aktas G, Kurt M. Does neutrophil-to-lymphocyte ratio predict active ulcerative colitis? Wien Klin Wochenschr. 2015: 262 [PMID: 25576331, https://doi.org/10.1007/s00508-014-0683-5]
18. Erge E, Kiziltunc C, Balci SB, Atak Tel BM, Bilgin S, Duman TT, Aktas G. A Novel Inflammatory Marker for the Diagnosis of Hashimoto's Thyroiditis: Platelet-Count-to-Lymphocyte-Count Ratio. Diseases. 2023: [PMID: 36810529, https://doi.org/10.3390/diseases11010015]
19. Perkovic V, Tuttle KR, Rossing P, Mahaffey KW, Mann JFE, Bakris G, Baeres FMM, Idorn T, Bosch-Traberg H, Lausvig NL, Pratley R, Committees FT, Investigators. Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes. N Engl J Med. 2024: 109 [PMID: 38785209, https://doi.org/10.1056/NEJMoa2403347]
20. Henao-Carrillo DC, Jurado-Florez MA, Munoz OM. Changes in glomerular filtration rate in patients with body mass index >/=35 kg/m(2) treated with metabolic and bariatric surgery versus GLP-1 agonist at 1-year follow-up. Obes Sci Pract. 2024: e782 [PMID: 39130193, https://doi.org/10.1002/osp4.782]
21. Mantovani A, Morandin R, Fiorio V, Lando MG, Stefan N, Tilg H, Byrne CD, Targher G. Glucagon-Like Peptide-1 Receptor Agonists Improve MASH and Liver Fibrosis: A Meta-Analysis of Randomised Controlled Trials. Liver Int. 2025: e70256 [PMID: 40736113, https://doi.org/10.1111/liv.70256]

This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Cigdem Cindoglu, Hüseyin Karaaslan, Nida Uyar, Ali Gökçe, Burcu Dikeç Gökçe, Mehmet Ali Eren

