Changing the approach to type 2 diabetes treatment: A comparison of glucagon‐like peptide‐1 receptor agonists and sulphonylureas across the continuum of care

Abstract

Despite the importance of individualised strategies for patients with type 2 diabetes mellitus (T2DM) and the availability of alternative treatments, including glucagonlike peptide-1 receptor agonists (GLP-1 RAs), sulphonylureas are still widely used in practice. Clinical evidence shows that GLP-1 RAs may provide better and more durable glycaemic control than sulphonylureas, with lower risk of hypoglycaemia.Other reported benefits of GLP-1 RAs include weight loss rather than weight gain (as observed with sulphonylureas), blood pressure reduction and improvement in lipid profiles. In general, the main adverse events with GLP-1 RAs are gastrointestinal in nature. The respective modes of action of GLP-1 RAs and sulphonylureas contribute to differences in the durability of glycaemic control (related to effects on beta-cells) and effects on body weight. Moreover, the glucose-dependent mode of action of GLP-1 RAs, which favours a low incidence of hypoglycaemia, contrasts with the glucose-independent mode of action of sulphonylureas. Evidence from cardiovascular outcomes trials indicates a consistent finding of cardiovascular safety across the GLP-1 RAs and suggests a class benefit for the long-acting GLP-1 RAs in reducing three-point major adverse cardiovascular events, cardiovascular mortality and all-cause mortality. In contrast, potential concerns relating to an increased incidence of adverse cardiovascular events with sulphonylureas have yet to be fully resolved. Recent updates to management guidelines recommend that treatment selection for patients with T2DM should consider clinical trial evidence of cardiovascular safety. Available evidence suggests that this selection should give preference to GLP-1 RAs over sulphonylureas, especially for patients at high cardiovascular risk.

Effect of dulaglutide injection on weight beyond glycemic control: real-world observational study

“…17 The differences between the mean reduction in HbA1c and SMBGs between this study and the AWARD trials could be attributed to the tolerability of the selected GLP-1 RA, background therapy, and the baseline HbA1c. 18 In Figure 3, we described the pattern of insulin adjustment for the 44 patients with T2DM with add-on Dulaglutide. The minimal contribution of the hypoglycemia to the adjustment and obtaining acceptable SMBGs results were the main motives for adjustment or stopping the insulin therapy in this subgroup of patients.…”

New practice in semaglutide on type-2 diabetes and obesity: clinical evidence and expectation

“…Furthermore, GLP-1 receptor agonist such as liraglutide provides better and longer glycemic control with a lower risk of hypoglycemia in individualized treatment of T2D patients. It showed as well an advantage in reducing major cardiovascular adverse events and mortality compared with other treatment regimens [26]. In general, GLP-1 receptor agonists are extensively used in the treatment of obesity and T2D.…”

Endogenous glucagon‐like peptide (GLP)‐1 as alternative for GLP‐1 receptor agonists: Could this work and how?

“…Glucagon‐like peptide (GLP)‐1 receptor agonists (GLP‐1RA) have received great interest because of their beneficial effects on glucose levels, eating behaviour, body weight, and off course the evidence that they reduce the risk of cardiovascular disease. Because of these benefits, GLP‐1RA is given preference as a second line agent over sulfonylureas 1 . Recent guidelines for the treatment of type 2 diabetes (T2D) have now included GLP‐1RA as the first‐line treatment in patients at high risk of atherosclerotic cardiovascular disease 2 .…”