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Glucagon-like peptide-1 receptor agonists (GLP-1RA) are a class of medications used to treat adult type 2 diabetes and obesity. They are in the drug class of incretin mimetics. Glucagon-like peptide-1 receptor agonists (GLP-1RA, GLP-1DAs, incretin mimetics, or GLP-1 analogs) are a class of medications utilized in treating type 2 diabetes and obesity. Clinical trials show the superiority of GLP-1RA to other antihyperglycemic drugs in improving glycemic efficacy, reducing weight and blood pressure, and having a cardioprotective effect, all without the risk of hypoglycemia. These drugs have transformed the guidelines for the management of diabetes. This activity reviews the indications, mechanism of action, adverse effects, and other critical elements of these drugs. In addition, this activity highlights the comparison between different GLP-1 receptor agonists within the same class based on pharmacokinetics, duration of action, efficacy, and safety profile pertinent to the interprofessional healthcare team in using this class of medications for treating diabetes, obesity, and their sequelae. Objectives: Identify appropriate candidates for GLP-1 receptor agonist therapy based on their type 2 diabetes diagnosis, glycemic control, and individualized treatment goals. Differentiate the various GLP-1 receptor agonists available, considering their pharmacokinetics, administration routes, dosing frequency, and potential adverse effects. Apply knowledge of the cardiovascular and weight-related benefits of GLP-1 receptor agonists to enhance patient care and incorporate these agents into a comprehensive treatment plan. Collaborate with other healthcare professionals, such as endocrinologists, dietitians, and pharmacists, to optimize patient care and ensure a coordinated approach to diabetes management. Access free multiple choice questions on this topic.

GLP-1 analog overdoses are few and far between. When they do occur, the symptoms include nausea, vomiting, and diarrhea, which have led to acute kidney injury likely secondary to dehydration. Excessive belching and abdominal pain have been reported as well. Serious complications like pancreatitis have not been experienced. There have been rare episodes of hypoglycemia that were corrected without long-term complications.[53][54] Several case reports have shown that an overdose of GLP-1RAs mainly causes GI symptoms but either no or minimal hypoglycemia. These patients' symptoms are managed supportively according to their symptoms, with intravenous fluids to hydrate the patient and antiemetic medications to control nausea and vomiting.[55][56][57]

GLP-1 receptor agonists are an effective therapeutic choice for patients with type 2 diabetes and obesity. There is robust evidence from clinical trials and meta-analyses that show that GLP-1 receptor agonists reduce HbA1c levels, aid weight loss, and improve cardiovascular outcomes.[58][59][60] An interprofessional team comprised of a primary care physician, advanced practice practitioners, an endocrinologist, a pharmacist, a diabetes educator, nursing staff, and a dietician should be utilized when treating type 2 diabetes and obese patients with a GLP-1 receptor agonist. Communication between these healthcare team members is the utmost priority. After reviewing the medication reconciliation and laboratory results, they should use a patient-centered, holistic, interprofessional approach regarding who would benefit from a GLP-1 receptor agonist and work as a team in monitoring therapy to optimize patient outcomes. GLP-1 receptor agonists may be limited due to their gastrointestinal side effects, subcutaneous injection route of administration, and cost. Pharmacists and clinicians should provide education by demonstrating how to administer the drug properly and safely. This will help with compliance rates and adherence to the regimen and improve patient satisfaction. Pharmacists can contribute by counseling patients on adverse effects, monitoring parameters, appropriate usage, drug interactions, and therapy goals with GLP-1 analogs, and advising them to report any concerns to the office. Pharmacists can also assist in navigating insurance coverage and out-of-pocket costs to arrive at the optimal agent and means of access, which can be facilitated by working with patient assistance programs, especially for patients for whom medication cost is a significant concern. If a patient is experiencing gastrointestinal adverse effects following dose titration, the patient should be asked to verify the dose and the time of symptom onset.

GLP-1 receptor agonists may be limited due to their gastrointestinal side effects, subcutaneous injection route of administration, and cost. Pharmacists and clinicians should provide education by demonstrating how to administer the drug properly and safely. This will help with compliance rates and adherence to the regimen and improve patient satisfaction. Pharmacists can contribute by counseling patients on adverse effects, monitoring parameters, appropriate usage, drug interactions, and therapy goals with GLP-1 analogs, and advising them to report any concerns to the office. Pharmacists can also assist in navigating insurance coverage and out-of-pocket costs to arrive at the optimal agent and means of access, which can be facilitated by working with patient assistance programs, especially for patients for whom medication cost is a significant concern. If a patient is experiencing gastrointestinal adverse effects following dose titration, the patient should be asked to verify the dose and the time of symptom onset. The healthcare team should institute routine follow-ups to monitor weight, kidney function, complete blood count, and blood glucose levels. A diabetic educator and a dietician can stress adding dietary changes and exercise while taking this medication for maximum treatment benefit. Dieticians also play a pivotal role by recommending smaller meals, eating more slowly, and avoiding fatty foods. Cost can be a significant barrier as these medications are expensive. A discussion should be initiated between patient and clinician to discuss cost-effectiveness and provide financial assistance if needed. A comprehensive interprofessional healthcare team can improve outcomes and quality of life for patients with type 2 diabetes, as it can minimize adverse events, and clinicians should support these patients in reaching their personalized treatment goals to benefit their health.

The healthcare team should institute routine follow-ups to monitor weight, kidney function, complete blood count, and blood glucose levels. A diabetic educator and a dietician can stress adding dietary changes and exercise while taking this medication for maximum treatment benefit. Dieticians also play a pivotal role by recommending smaller meals, eating more slowly, and avoiding fatty foods. Cost can be a significant barrier as these medications are expensive. A discussion should be initiated between patient and clinician to discuss cost-effectiveness and provide financial assistance if needed. A comprehensive interprofessional healthcare team can improve outcomes and quality of life for patients with type 2 diabetes, as it can minimize adverse events, and clinicians should support these patients in reaching their personalized treatment goals to benefit their health. The comparison of GLP-1 receptor agonists has demonstrated that they all effectively reduce HbA1c levels in patients with type 2 diabetes. However, the agents vary within the class based on efficacy, safety, adverse effect profile, cardiovascular and renal effects, adherence, and persistence. When selecting a GLP-1 receptor agonist for a patient, a multidisciplinary healthcare team must consider all the available clinical evidence and individual patient factors like preference, cost, accessibility, and convenience. Regarding the most significant reduction of HbA1c, long-acting agents seem superior to short-acting agents, with semaglutide having the most significant decrease. The lowest reduction was with exenatide extended-release. However, the drug was still more effective at lowering the HbA1C than short-acting agents. For weight loss, the long-acting GLP-1 receptor agonists produced more significant weight loss than the short-acting formulations. Semaglutide was noted to cause the most significant weight reduction. The most gastrointestinal adverse effects were seen with short-acting agents and subcutaneous semaglutide, and the fewest side effects were seen with exenatide ER.

The comparison of GLP-1 receptor agonists has demonstrated that they all effectively reduce HbA1c levels in patients with type 2 diabetes. However, the agents vary within the class based on efficacy, safety, adverse effect profile, cardiovascular and renal effects, adherence, and persistence. When selecting a GLP-1 receptor agonist for a patient, a multidisciplinary healthcare team must consider all the available clinical evidence and individual patient factors like preference, cost, accessibility, and convenience. Regarding the most significant reduction of HbA1c, long-acting agents seem superior to short-acting agents, with semaglutide having the most significant decrease. The lowest reduction was with exenatide extended-release. However, the drug was still more effective at lowering the HbA1C than short-acting agents. For weight loss, the long-acting GLP-1 receptor agonists produced more significant weight loss than the short-acting formulations. Semaglutide was noted to cause the most significant weight reduction. The most gastrointestinal adverse effects were seen with short-acting agents and subcutaneous semaglutide, and the fewest side effects were seen with exenatide ER. Patient satisfaction, adherence, and persistence were seen more with long-acting agents, likely due to their less frequent dosing of once-weekly injections compared to once-daily or twice-daily of the short-acting agents. These comparative factors should be integral to the healthcare clinician’s decision to choose a GLP-1 receptor agonist.