From the Guidelines
Before initiating GLP-1 receptor agonist therapy, it is crucial to check a comprehensive metabolic panel, hemoglobin A1C, fasting glucose, thyroid function tests, amylase, lipase, and pregnancy testing in women of childbearing age, as these tests help establish baseline values and ensure the medication's safety and efficacy 1.
Laboratory Tests for GLP-1 Receptor Agonists
The following laboratory tests should be considered before starting GLP-1 receptor agonist medication:
- Comprehensive metabolic panel to assess kidney and liver function, as these medications are primarily cleared by the kidneys and some require dose adjustments for renal impairment 1
- Hemoglobin A1C and fasting glucose to establish baseline glycemic control
- Thyroid function tests, as medullary thyroid carcinoma is a rare but serious risk with some GLP-1 agonists
- Amylase and lipase levels, as pancreatitis is a potential adverse effect
- Pregnancy testing in women of childbearing age, since GLP-1 agonists are not recommended during pregnancy
Considerations for Patients with Chronic Kidney Disease
For patients with chronic kidney disease, it is essential to consider the dose adjustments for GLP-1 receptor agonists based on the estimated glomerular filtration rate (eGFR) 1.
- Dulaglutide, liraglutide, and injectable semaglutide do not require dose adjustments, regardless of eGFR
- Exenatide requires caution when initiating or increasing the dose, and its use is not recommended in patients with eGFR < 30 mL/min/1.73 m²
- Lixisenatide does not require dose adjustments for eGFR 30-59 mL/min/1.73 m², but its use is not recommended in patients with eGFR < 15 mL/min/1.73 m²
Conclusion is not allowed, so the answer will be ended here.
From the FDA Drug Label
Laboratory Tests Bilirubin Calcitonin Lipase and Amylase
The labs that should be checked before GLP-1 (liraglutide) include:
- Bilirubin: to monitor for mildly elevated serum bilirubin concentrations
- Calcitonin: as a biological marker of MTC
- Lipase and Amylase: to monitor for elevations in lipase or amylase, which may indicate pancreatitis 2
From the Research
Laboratory Tests Before GLP-1 Receptor Agonist Therapy
There are no specific laboratory tests mentioned in the provided studies that are required to be checked before initiating GLP-1 receptor agonist therapy. However, the following laboratory tests may be relevant in the management of patients with type 2 diabetes:
- A1C levels to assess glycemic control 3, 4
- Renal function tests to monitor for potential renal adverse events 5, 6
- Liver function tests to monitor for potential liver injury 5
- Lipid profiles to monitor for potential changes in lipid levels 3
- Blood pressure monitoring to assess for potential changes in blood pressure 3, 7
Potential Contraindications and Warnings
The following potential contraindications and warnings should be considered before initiating GLP-1 receptor agonist therapy:
- History of pancreatitis or pancreatic cancer 5
- History of thyroid cancer 5
- Severe gastrointestinal disease 5
- Severe renal impairment 6
- Hypersensitivity to the medication or any of its components 5
Monitoring During Therapy
The following laboratory tests and monitoring may be relevant during GLP-1 receptor agonist therapy:
- Regular monitoring of A1C levels to assess glycemic control 3, 4
- Regular monitoring of renal function tests to monitor for potential renal adverse events 5, 6
- Regular monitoring of liver function tests to monitor for potential liver injury 5
- Regular monitoring of blood pressure to assess for potential changes in blood pressure 3, 7
- Monitoring for potential gastrointestinal adverse events such as nausea, vomiting, diarrhea, and abdominal pain 5