GLP-1 Receptor Agonists

Oct 10, 2015The Diabetes educator

Important Points for Using GLP-1 Receptor Agonist Medicines in Medical Care

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GLP-1 Therapies on OpenScience ↗PubMed ↗DOI ↗

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are recommended for managing type 2 diabetes (T2D) and can lead to improved glycemic control.

GLP-1RAs are effective in lowering A1C levels and are associated with weight loss and improved cardiovascular risk markers.
Shorter-acting GLP-1RAs provide better management of post-meal blood sugar spikes, while longer-acting versions enhance fasting blood sugar control.
Reductions in body weight and blood pressure are similar across different GLP-1RA agents, with some increase in heart rate that lacks clear clinical significance.
Gastrointestinal side effects tend to decrease over time and occur less frequently with longer-acting formulations.
The incidence of hypoglycemia is low but may rise when GLP-1RAs are combined with insulin or insulin secretagogues.
Differences among GLP-1RAs may influence the choice of treatment for individual patients with T2D.

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PURPOSE: Type 2 diabetes (T2D) imparts an increased risk of adverse health outcomes in patients unable to achieve glycemic control. Patient education and individualization of treatment are important for effective management of T2D. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a class of injectable glucose-lowering agents that lower A1C with added benefits of weight loss and improved cardiovascular risk markers. This review discusses the role of GLP-1RAs currently approved in the United States (exenatide, liraglutide, albiglutide, dulaglutide) for T2D management and characterizes the efficacy and safety profiles of individual GLP-1RAs.

CONCLUSIONS: GLP-1RAs are recommended as a preferred add-on agent to existing metformin monotherapy, as first-line therapy if metformin is contraindicated or poorly tolerated, and for use in combination with other oral glucose-lowering agents or basal insulin. Shorter-acting GLP-1RAs (exenatide and liraglutide) offer improved coverage of postprandial hyperglycemia, while longer-acting GLP-1RA formulations (exenatide extended-release, dulaglutide, and albiglutide) further improve fasting plasma glucose, which can result in additional A1C lowering. Reductions in body weight and blood pressure appear similar among individual agents, and small increases in heart rate are of unknown clinical relevance. Gastrointestinal adverse events abate over time with continued treatment and are less frequent with longer-acting GLP-1RAs. Hypoglycemia incidence is low but increased when GLP-1RAs are used with insulin secretagogues or insulin. GLP-1RAs target multiple pathophysiologic mechanisms in patients with T2D and improve glycemic control, although there are some differences within this drug class that may be relevant in clinical practice. Therefore, selection of the most appropriate treatment for individual patients is important.

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GLP-1 Receptor Agonists

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