Underuse of GLP-1 receptor agonists in the management of type 2 diabetes despite a favorable benefit-safety profile

May 13, 2024Expert opinion on drug safety

Low use of GLP-1 receptor drugs for type 2 diabetes despite their good benefits and safety

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GLP-1 Therapies on OpenScience ↗PubMed ↗DOI ↗

Abstract

Only a minority of patients with type 2 diabetes receive GLP-1 receptor agonists, despite their cardiovascular benefits.

GLP-1 receptor agonists are effective in reducing major cardiovascular events in high-risk patients with type 2 diabetes.
Evidence from both placebo-controlled trials and observational studies supports their efficacy compared to other glucose-lowering agents.
These medications have a favorable safety profile and a positive benefit/risk ratio for managing type 2 diabetes.
International guidelines recommend GLP-1 receptor agonists for patients with atherosclerotic cardiovascular disease and as an alternative for overweight or obese patients.
Real-life studies indicate a trend towards increased prescriptions, but still show underuse among patients with established atherosclerotic cardiovascular disease.

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INTRODUCTION: Patients with type 2 diabetes (T2DM) are at high risk of atherosclerotic cardiovascular disease (ASCVD) and cardiovascular death. Cardiovascular protection is a key objective in T2DM.

AREAS COVERED: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have proven their efficacy in reducing major cardiovascular events in high-risk patients with T2DM in placebo-controlled trials, a finding confirmed in observational studies compared with other glucose-lowering agents. Overall, GLP-1RAs have a good safety profile associated with a favorable benefit/risk ratio for the management of T2DM, even if their cost-effectiveness might be questionable. International guidelines recommend GLP-1RAs as preferred glucose-lowering agents in patients with ASCVD and as a valuable alternative in overweight/obese patients with T2DM. However, real-life studies worldwide revealed that only a minority of patients receive a GLP-1RA, despite a positive trend for increased prescriptions in recent years. Surprisingly, however, fewer patients with established ASCVD are treated with these cardioprotective antihyperglycemic agents versus patients without ASCVD.

EXPERT OPINION: The reasons for GLP-1RA underuse in clinical practice are multiple. Multifaceted and coordinated interventions targeting all actors of the health-care system must be implemented to stimulate the adoption of GLP-1RAs as part of routine cardiovascular care among patients with T2DM, especially in those with ASCVD.

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Underuse of GLP-1 receptor agonists in the management of type 2 diabetes despite a favorable benefit-safety profile

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