Glucagon-Like Peptide-1 Receptor Agonists in Type 2 Diabetes: Their Use and Differential Features

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are well established as effective adjuncts to lifestyle modification in the treatment of type 2 diabetes (T2D) as monotherapy or in combination with oral glucose-lowering drugs ± insulin. The six subcutaneous GLP-1RA formulations (i.e. twice-daily exenatide, once-daily liraglutide and lixisenatide, and once-weekly dulaglutide, exenatide and semaglutide) currently available in the EU and USA have many similarities, but also some unique features and properties. By stimulating GLP-1 receptors, GLP-1RAs increase insulin secretion and suppress glucagon release in a glucose-dependent manner, thereby improving clinical and patient-reported outcomes related to glycaemic control and weight. They also have been shown to reduce, or at least not increase, the risk of major cardiovascular outcomes. GLP-1RAs are generally well tolerated, with gastrointestinal and injection-site reactions being the most troublesome drug-related adverse events, and are associated with a very low intrinsic risk of hypoglycaemia. Treatment with GLP-1RAs should be customized to meet the clinical needs and personal preferences of the individual. Enhanced material for this Adis Disease Management article (including translations) can be found at https ://doi.org/10.6084/ m9.figsh are.11320 370.

Clinical review of the efficacy and safety of oral semaglutide in patients with type 2 diabetes considered for injectable GLP-1 receptor agonist therapy or currently on insulin therapy

“…The AE profile for oral semaglutide in the two PIONEER trials was consistent with the AE profile seen with the GLP-1RA class [36][37][38]. In both PIONEER 4 and 8, the most frequently reported AEs with oral semaglutide were gastrointestinal in nature, most commonly nausea or diarrhea (Table 5) [32,33].…”

Integrating oral semaglutide into clinical practice in primary care: for whom, when, and how?

“…As discussed in detail in the first article in this supplement [43], subcutaneous GLP-1RAs are currently associated with adherence/ persistence rates that indicate room for improvement [44][45][46]. While there is likely a myriad of factors contributing to these rates, in part they are likely to relate to patient and health-care provider concerns regarding injections, including perceived pain, inconvenience, and administration challenges [47][48][49][50].…”

“…It should also be noted that oral semaglutide is not indicated for patients with type 1 diabetes or for the treatment of diabetic ketoacidosis, nor has it been studied in those with a history of pancreatitis [9]. The prescribing information notes that upper GI disease (including chronic gastritis and/or gastroesophageal reflux disease) does not affect the pharmacokinetics of oral semaglutide [9]; however, consistent with recommendations for other GLP-1RAs [10,12,13,15,48,57], the authors would not recommend oral semaglutide for patients with gastroparesis.…”

Glucagon-like Peptide-1 Receptor Agonists: Limitless Potential

“…В среднем лекарственные средства из данной группы понижают уровень HbA1c на 1-1,5% [20]. Важно, что дейст вие арГПП-1 проявляется лишь в условиях гипергликемии (вследствие глюкозозависимой секреции инсулина ENDOCRINOLOGY и подав ления синтеза глюкагона), что уменьшает риск эпизодов гипогликемии [21].…”