Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a class of medication used to treat type 2 diabetes in patients uncontrolled on metformin.
As well as effectively lowering HbA1c, GLP-1 RAs have the potential to address multiple risk factors in your type 2 diabetes patients.1–3
Below you will find the latest information about developments in GLP-1 science and GLP-1 RA therapy to keep you up to date.
Watch this short video to see how shifting your approach to type 2 diabetes management with a GLP-1 RA could benefit your patients.
In this video, Associate Prof. Sam Hocking discusses the potential benefits of GLP-1 RAs beyond glucose lowering, including benefits on weight reduction, blood lipids and blood pressure that could make the drug class an important option to consider in people living with type 2 diabetes who are uncontrolled on metformin.1–3
GLP-1 RAs can vary in their molecular size and structure, which may impact on the individual efficacy and safety profile of the different agents.3–6
For agent-specific recommendations, please refer to the manufacturers’ prescribing information.
For more videos and other educational materials, visit the Resources page →
GLP-1 RA: Glucagon-like peptide-1 receptor agonist
When people living with type 2 diabetes are uncontrolled on metformin, it is important to consider which treatment will enable your patients to maintain glycaemic control.37
Improvement in blood glucose levels is associated with greater adherence to therapy and further maintaining adequate glycaemic control which, in turn, reduces the long-term risk of type 2 diabetes complications.37
In studies comparing a GLP-1 RA with other glucose-lowering therapies, all in combination with metformin, GLP-1 RA had a longer time to inadequate HbA1c control (HbA1c >7.0%) demonstrating a durability of treatment effect that could help patients adhere to therapy, delay further intensification and reduce the risk of future complications.37,38
When intensifying type 2 diabetes therapy in a primary care setting, a GLP-1 RA may help your patients stay controlled on therapy for longer.37,38
*For agent-specific recommendations, please refer to the manufacturers’ prescribing information.
CV: Cardiovascular; DPP-4i: Dipeptidyl peptidase 4 inhibitor; GLP-1 RA: Glucagon-like peptide-1 receptor agonist; SGLT2i: Sodium-glucose cotransporter 2 inhibitor.
The most reported side effects with GLP-1 RAs are nausea (typically reported in up to 25% of patients), vomiting, and diarrhoea (each reported in up to 10% of patients). These symptoms are often summarised as gastrointestinal adverse events. They are typically most prominent when initiating treatment with any GLP-1 RA or after increasing the dose.4
For most patients, these symptoms are short, self-limited episodes that cease spontaneously, even with continued treatment.4
An often-used recommendation to avoid these adverse events is a standardised, slowly increased exposure through increase in dose, which has been shown to mitigate gastrointestinal side effects.4
GLP-1 RAs are well suited for early use in type 2 diabetes, since they stimulate release of insulin and suppress glucagon secretion only when blood glucose levels are elevated keeping the risk of hypoglycemia low.48,49
As glucose levels decrease, so does the effect of GLP-1 RA on insulin secretion.49
Hypoglycaemic episodes have been reported in patients taking GLP-1 RAs but mostly when combined with therapies such as sulfonylureas or insulin.4
Acute pancreatitis has been observed with the use of GLP-1 RAs. Patients should be informed of the characteristic symptoms of acute pancreatitis. If pancreatitis is suspected, treatment should be discontinued. Caution should be exercised when using GLP-1 RAs in patients with diabetic retinopathy. These patients should be monitored closely and treated according to clinical guidelines.
For further important safety information on GLP-1 RAs please refer to the manufacturers’ prescribing information for each individual agent.
The current ADA/EASD consensus algorithm suggests that GLP-1 RAs should be preferentially used after metformin failure in patients with established atherosclerotic cardiovascular disease or other high-risk indicators. Guidelines also recommend that GLP-1 RAs can also be used to prevent weight gain and hypoglycemia.1,4,50
The ESC guidelines have gone even further in recommending GLP-1 RAs (or SGLT2is) as first-line therapy in patients with established atherosclerotic cardiovascular disease or in those at high or very high risk. According to these international recommendations, 30–60% of patients with type 2 diabetes could qualify for a GLP-1 RA.4
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Kristensen SL, Rørth R, Jhund PS et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet Diabetes Endocrinol. 2019;7(10):776–785.
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Data on file. IQVIA Midas December 2020, IQVIA Disease Analyser Germany December 2020, LAAD USA November 2020.
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