From the Guidelines
Semaglutide is currently considered the most effective GLP-1 agonist for both weight loss and glycemic control, as evidenced by its superior efficacy in reducing HbA1c and body weight compared to other GLP-1 agonists, such as liraglutide 1.
Key Points
- Semaglutide has been shown to reduce HbA1c by 1.5-2.0% and produce 15-20% body weight reduction, outperforming earlier GLP-1 medications 1.
- The LEADER trial demonstrated that liraglutide, another GLP-1 receptor agonist, reduced the primary composite outcome of cardiovascular death, nonfatal MI, or nonfatal stroke by 13% compared to placebo 1.
- However, semaglutide has been shown to have a longer half-life and better patient adherence due to its weekly dosing, making it a more effective option for long-term weight loss and glycemic control 1.
- Common side effects of semaglutide include nausea, vomiting, and diarrhea, which typically improve over time, and treatment usually begins with a lower dose that gradually increases over several weeks to minimize these gastrointestinal effects 1.
Comparison to Other GLP-1 Agonists
- Liraglutide, another GLP-1 receptor agonist, has been shown to be effective in reducing HbA1c and body weight, but its efficacy is lower compared to semaglutide 1.
- Other GLP-1 agonists, such as lixisenatide, have also been studied, but their efficacy is not as well established as semaglutide and liraglutide 1.
Clinical Implications
- Semaglutide is a valuable treatment option for patients with type 2 diabetes and obesity, offering improved glycemic control and weight loss compared to other GLP-1 agonists 1.
- Healthcare providers should consider semaglutide as a first-line treatment option for patients with type 2 diabetes and obesity, taking into account its efficacy, safety, and patient adherence 1.
From the Research
GLP-1 Agonists Overview
- GLP-1 receptor agonists (GLP-1 RAs) are a class of glucose-lowering agents used to treat type 2 diabetes 2, 3, 4, 5, 6
- They work by augmenting hyperglycemia-induced insulin secretion, suppressing glucagon secretion, decelerating gastric emptying, and reducing calorie intake and body weight 2, 5
Types of GLP-1 Agonists
- Short-acting agents: exenatide b.i.d., lixisenatide 2, 3, 4, 5
- Long-acting agents: liraglutide, once-weekly exenatide, dulaglutide, albiglutide, and semaglutide 2, 3, 4, 5, 6
- Oral preparation: semaglutide, which has demonstrated clinical effectiveness close to the once-weekly subcutaneous preparation 2, 6
Efficacy and Safety
- All GLP-1 RAs are effective therapeutic options for reducing A1C, with differences in magnitude of effect and frequency of adverse effects 3
- Long-acting GLP-1 RAs have more profound effects on overnight and fasting plasma glucose and HbA1c 2
- Once-daily oral semaglutide 14 mg is associated with significantly greater HbA1c reductions and weight reductions compared to most injectable GLP-1 RAs 6
Clinical Use
- GLP-1 RAs are recommended as the preferred first injectable glucose-lowering therapy for type 2 diabetes, even before insulin treatment 2
- They can be combined with basal insulin in either free- or fixed-dose preparations 2, 5, 6
- The choice of a specific GLP-1 receptor agonist depends on patient preferences, potential adverse effects, and cost 4, 5