title: GLP-1 Receptor Agonists: Practical Considerations for Clinical Practice.
abstract: OBJECTIVE
  Type 2 diabetes (T2D) imparts an increased risk of adverse health outcomes in patients unable to achieve glycemic control. Patient education and individualization of treatment are important for effective management of T2D. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a class of injectable glucose-lowering agents that lower A1C with added benefits of weight loss and improved cardiovascular risk markers. This review discusses the role of GLP-1RAs currently approved in the United States (exenatide, liraglutide, albiglutide, dulaglutide) for T2D management and characterizes the efficacy and safety profiles of individual GLP-1RAs.
  
  
  CONCLUSIONS
  GLP-1RAs are recommended as a preferred add-on agent to existing metformin monotherapy, as first-line therapy if metformin is contraindicated or poorly tolerated, and for use in combination with other oral glucose-lowering agents or basal insulin. Shorter-acting GLP-1RAs (exenatide and liraglutide) offer improved coverage of postprandial hyperglycemia, while longer-acting GLP-1RA formulations (exenatide extended-release, dulaglutide, and albiglutide) further improve fasting plasma glucose, which can result in additional A1C lowering. Reductions in body weight and blood pressure appear similar among individual agents, and small increases in heart rate are of unknown clinical relevance. Gastrointestinal adverse events abate over time with continued treatment and are less frequent with longer-acting GLP-1RAs. Hypoglycemia incidence is low but increased when GLP-1RAs are used with insulin secretagogues or insulin. GLP-1RAs target multiple pathophysiologic mechanisms in patients with T2D and improve glycemic control, although there are some differences within this drug class that may be relevant in clinical practice. Therefore, selection of the most appropriate treatment for individual patients is important.
authors.affiliation: University of Texas Health Science Center, Texas Diabetes Institute, San Antonio, Texas (Dr Triplitt, Dr Solis-Herrera) triplitt@uthscsa.edu.
authors.forename: Curtis
authors.initials: C
authors.lastname: Triplitt
authors.affiliation: University of Texas Health Science Center, Texas Diabetes Institute, San Antonio, Texas (Dr Triplitt, Dr Solis-Herrera).
authors.forename: Carolina
authors.initials: C
authors.lastname: Solis-Herrera
mesh_terms: D001786:Blood Glucose / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D000077270:Exenatide; D052216:Glucagon-Like Peptide 1 / Q000031:analogs & derivatives / Q000494:pharmacology; D004763:Glucagon-Like Peptides / Q000031:analogs & derivatives / Q000494:pharmacology; D006442:Glycated Hemoglobin / Q000187:drug effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology*; D007141:Immunoglobulin Fc Fragments / Q000494:pharmacology; D007328:Insulin / Q000627:therapeutic use; D000069450:Liraglutide / Q000494:pharmacology; D008687:Metformin / Q000627:therapeutic use; D010455:Peptides / Q000494:pharmacology; D011993:Recombinant Fusion Proteins / Q000494:pharmacology; D012307:Risk Factors; D014688:Venoms / Q000494:pharmacology; D000097789:Glucagon-Like Peptide-1 Receptor Agonists
chemical_list: D001786:Blood Glucose; D000077270:Exenatide; D052216:Glucagon-Like Peptide 1; D004763:Glucagon-Like Peptides; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007141:Immunoglobulin Fc Fragments; D007328:Insulin; D000069450:Liraglutide; D008687:Metformin; D010455:Peptides; D011993:Recombinant Fusion Proteins; D014688:Venoms; D000097789:Glucagon-Like Peptide-1 Receptor Agonists; C517652:hemoglobin A1c protein, human; C534611:rGLP-1 protein; C555680:dulaglutide