ABSTRACT
Over recent decades, an improved understanding of the pathophysiology of type 2 diabetes mellitus (T2DM) and glucose regulation has led to innovative research and new treatment paradigms. The discovery of the gut peptide glucagon-like peptide-1 (GLP-1) and its role in glucose regulation paved the way for the class of GLP-1 receptor agonist compounds, or GLP-1RAs. The long-acting GLP-1RAs (dulaglutide, exenatide extended-release, liraglutide, semaglutide [injectable and oral]) are classified as such based on a minimum 24-hour duration of clinically relevant effects after administration. In phase 3 clinical trial programs of long-acting GLP-1RAs, A1C typically was reduced in the range of 1% to 1.5%, with reductions close to 2% in some studies. GLP-1RAs when used alone (without sulfonylureas or insulin) have a low risk of hypoglycemia because, like endogenous GLP-1, their insulinotropic effects are glucose-dependent. In addition to local actions in the gastrointestinal (GI) tract, GLP-1RAs stimulate receptors in the central nervous system to increase satiety, resulting in weight loss. All long-acting GLP-1RAs have, at minimum, been shown to be safe and not increase cardiovascular (CV) risk and most (liraglutide, semaglutide injectable, dulaglutide, albiglutide) have been shown in CV outcomes trials (CVOTs) to significantly reduce the risk of major cardiac adverse events. The class has good tolerability overall, with generally transient GI adverse events being most common. The weekly injectable agents offer scheduling convenience and may promote treatment adherence. One long-acting GLP-1RA is available as an oral daily tablet, which may be preferable for some patients and providers.
Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Exenatide/administration & dosage , Glucagon-Like Peptide-1 Receptor/agonists , Glucagon-Like Peptides/analogs & derivatives , Immunoglobulin Fc Fragments/administration & dosage , Liraglutide/administration & dosage , Recombinant Fusion Proteins/administration & dosage , Administration, Oral , Delayed-Action Preparations , Exenatide/pharmacology , Glucagon-Like Peptide 1/physiology , Glucagon-Like Peptides/administration & dosage , Glucagon-Like Peptides/pharmacology , Heart Disease Risk Factors , Humans , Immunoglobulin Fc Fragments/pharmacology , Injections , Liraglutide/pharmacology , Recombinant Fusion Proteins/pharmacology , Satiety Response/drug effects , Weight Loss/drug effectsABSTRACT
Over recent decades, an improved understanding of the pathophysiology of type 2 diabetes mellitus (T2DM) and glucose regulation has led to innovative research and new treatment paradigms. The discovery of the gut peptide glucagon-like peptide-1 (GLP-1) and its role in glucose regulation paved the way for the class of GLP-1 receptor agonist compounds, or GLP-1RAs. The long-acting GLP-1RAs (dulaglutide, exenatide extended-release, liraglutide, semaglutide [injectable and oral]) are classified as such based on a minimum 24-hour duration of clinically relevant effects after administration. In phase 3 clinical trial programs of long-acting GLP-1RAs, A1C typically was reduced in the range of 1% to 1.5%, with reductions close to 2% in some studies. GLP-1RAs when used alone (without sulfonylureas or insulin) have a low risk of hypoglycemia because, like endogenous GLP-1, their insulinotropic effects are glucose-dependent. In addition to local actions in the gastrointestinal (GI) tract, GLP-1RAs stimulate receptors in the central nervous system to increase satiety, resulting in weight loss. All long-acting GLP-1RAs have, at minimum, been shown to be safe and not increase cardiovascular (CV) risk and most (liraglutide, semaglutide injectable, dulaglutide, albiglutide) have been shown in CV outcomes trials (CVOTs) to significantly reduce the risk of major cardiac adverse events. The class has good tolerability overall, with generally transient GI adverse events being most common. The weekly injectable agents offer scheduling convenience and may promote treatment adherence. One long-acting GLP-1RA is available as an oral daily tablet, which may be preferable for some patients and providers.
Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Glucagon-Like Peptide 1/therapeutic use , Glucagon-Like Peptide-1 Receptor/agonists , Glucagon-Like Peptides/analogs & derivatives , Hypoglycemic Agents/therapeutic use , Immunoglobulin Fc Fragments/therapeutic use , Liraglutide/therapeutic use , Recombinant Fusion Proteins/therapeutic use , Administration, Oral , Delayed-Action Preparations , Diabetes Mellitus, Type 2/metabolism , Glucagon-Like Peptide 1/pharmacology , Glucagon-Like Peptide 1/physiology , Glucagon-Like Peptides/administration & dosage , Glucagon-Like Peptides/pharmacology , Glucagon-Like Peptides/therapeutic use , Glucose/metabolism , Glycated Hemoglobin/metabolism , Humans , Hypoglycemic Agents/administration & dosage , Hypoglycemic Agents/pharmacology , Immunoglobulin Fc Fragments/administration & dosage , Immunoglobulin Fc Fragments/pharmacology , Liraglutide/administration & dosage , Liraglutide/pharmacology , Recombinant Fusion Proteins/administration & dosage , Recombinant Fusion Proteins/pharmacology , Safety , Treatment OutcomeABSTRACT
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality for patients with diabetes. The latest guidelines from the American Diabetes Association include new information on hypertension, lipid management, heart failure, and coronary heart disease. This year, for the first time, the cardiovascular disease and risk management section was endorsed by the American College of Cardiology. Primary and secondary prevention of ASCVD is a critical element of the primary care visit for patients with diabetes. This article provides key highlights that are important for busy clinicians.
