Glucagon-like peptide 1 receptor agonists in type 1 diabetes mellitus

Oct 16, 2019American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

Glucagon-like peptide 1 receptor activators in type 1 diabetes

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Abstract

GLP-1 receptor agonists may facilitate weight loss and reduce daily insulin requirements in type 1 diabetes mellitus.

GLP-1 receptor agonists address alpha cell dysfunction by suppressing glucagon secretion.
Evidence suggests weight loss and decreased total daily insulin requirements in type 1 diabetes patients using GLP-1 receptor agonists.
Modest improvements in glycemic control have been observed with GLP-1 receptor agonist therapy.
This therapy appears well tolerated, with nonsignificant increases in hypoglycemia risk.
Patients with detectable C-peptide, those who are overweight, or who struggle to achieve glycemic goals without hypoglycemia may benefit most from this treatment.

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PURPOSE: The role of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) in the treatment of type 1 diabetes mellitus (T1DM), including efficacy and safety evidence, is reviewed.

SUMMARY: Currently approved treatment options for glycemic control in T1DM include insulin, which combats insulin deficiency but does not effectively target disease progression or alpha cell dysfunction; and pramlintide, whose use requires multiple daily doses and involves a high likelihood of gastrointestinal side effects. GLP-1 RAs have a unique mechanism of action in T1DM, addressing alpha cell dysfunction and thereby suppressing inappropriate glucagon secretion. GLP-1 RA dosing varies from once weekly to twice daily, and the class is well tolerated in patients with type 2 diabetes. Among the GLP-1 RAs, exenatide and liraglutide have been studied in patients with T1DM, with published evidence consistently demonstrating weight loss, decreases in total daily insulin requirements, and modest improvements in glycemic control. GLP-1 RA therapy appears to be well tolerated in patients with T1DM and is associated with nonsignificant increases in hypoglycemia risk.

CONCLUSION: GLP-1 RA therapy represents an important add-on therapy option for achieving decreased insulin doses, weight loss, and modest improvements in HbA1c levels without significantly increasing hypoglycemia risk in patients with T1DM. Patients who have detectable C-peptide and/or are overweight or cannot achieve glycemic goals without hypoglycemia have been found to benefit the most from GLP-1 RA therapy. Further studies are warranted to evaluate these agents' potential impact on clinical outcomes such as microvascular and macrovascular complications.

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Glucagon-like peptide 1 receptor agonists in type 1 diabetes mellitus

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