A clinical review of GLP-1 receptor agonists: efficacy and safety in diabetes and beyond

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The prevalence of type 2 diabetes is increasing at an astounding rate. Many of the agents used to treat type 2 diabetes have undesirable adverse effects of hypoglycemia and weight gain. Glucagon-like peptide-1 (GLP-1) receptor agonists represent a unique approach to the treatment of diabetes, with benefits extending outside glucose control, including positive effects on weight, blood pressure, cholesterol levels, and beta-cell function. They mimic the effects of the incretin hormone GLP-1, which is released from the intestine in response to food intake. Their effects include increasing insulin secretion, decreasing glucagon release, increasing satiety, and slowing gastric emptying. There are currently four approved GLP-1 receptor agonists in the United States: exenatide, liraglutide, albiglutide, and dulaglutide. A fifth agent, lixisenatide, is available in Europe. There are important pharmacodynamic, pharmacokinetic, and clinical differences of each agent. The most common adverse effects seen with GLP-1 therapy include nausea, vomiting, and injection-site reactions. Other warnings and precautions include pancreatitis and thyroid cell carcinomas. GLP-1 receptor agonists are an innovative and effective option to improve blood glucose control, with other potential benefits of preserving beta-cell function, weight loss, and increasing insulin sensitivity. Once-weekly formulations may also improve patient adherence. Overall, these are effective agents for patients with type 2 diabetes, who are either uncontrolled on metformin or intolerant to metformin.

Keywords: type 2 diabetes mellitus, glucagon-like peptide-1 receptor agonist, subcutaneous, albiglutide, dulaglutide, liraglutide, exenatide, beta cell, insulin sensitivity, weight loss.

Abbreviation: GLP-1, Glucagon-like peptide-1.

Citation: Prasad-Reddy L, Isaacs D. A clinical review of GLP-1 receptor agonists: efficacy and safety in diabetes and beyond. Drugs in Context 2015; 4: 212283. DOI: 10.7573/dic.212283

Contributions: LPR and DI had full access to all of the data in the review and take responsibility for the integrity of the data and the accuracy of the data analysis. Interpretation of data: LPR and DI; drafting of the manuscript: LPR, DI; critical revision of the manuscript for content: LPR, DI; administrative, technical, or material support: LPR, DI.

Potential conflicts of interest: The International Committee of Medical Journal Editors’ (ICMJE) Potential Conflicts of Interests forms for the authors are available for download at: https://www.drugsincontext.com/wp-content/uploads/2015/07/dic.212283-COI.pdf. The authors declare no conflicts of interest.

Funding declaration: None to declare.

Copyright: Copyright © 2015 Prasad-Reddy L, Isaacs D. Distributed under the terms of the Creative Commons License Deed CC BY NC ND 3.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correction attribution: Copyright © 2015 Prasad-Reddy L, Isaacs D. http://dx.doi.org/10.7573/dic.212283. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 3.0.

Article URL: https://www.drugsincontext.com/a-clinical-review-of-glp-1-receptor-agonists-efficacy-and-safety-in-diabetes-and-beyond

Correspondence: Lalita Prasad-Reddy, PharmD, MS, BCPS, BCACP, Clinical Assistant Professor, Chicago State University College of Pharmacy, 9501 S. King Drive/Douglas Hall 206, Chicago, IL 60628, USA. lprasad@csu.edu

Provenance: Invited; externally peer reviewed

Submitted: 8 May 2015; Peer review comments to author: 28 May 2015; Published: 9 July 2015

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