What is the current list of all Glucagon-like peptide-1 (GLP-1) and Sodium-glucose cotransporter 2 (SGLT2) medications used for diabetes and weight management?

From the Guidelines

GLP-1 receptor agonists and SGLT2 inhibitors are two medication classes used for both diabetes management and weight loss, with current GLP-1 medications including semaglutide, dulaglutide, liraglutide, tirzepatide, exenatide, and lixisenatide, and SGLT2 inhibitors including empagliflozin, dapagliflozin, canagliflozin, and ertugliflozin, as recommended by the most recent guidelines 1.

Key Medications

• GLP-1 receptor agonists:

• Semaglutide (Ozempic, Wegovy, Rybelsus)
• Dulaglutide (Trulicity)
• Liraglutide (Victoza, Saxenda)
• Tirzepatide (Mounjaro, Zepbound)
• Exenatide (Byetta, Bydureon)
• Lixisenatide (Adlyxin)

• SGLT2 inhibitors:

• Empagliflozin (Jardiance)
• Dapagliflozin (Farxiga)
• Canagliflozin (Invokana)
• Ertugliflozin (Steglatro)

Mechanism of Action

• GLP-1 receptor agonists: mimic the incretin hormone GLP-1, increasing insulin secretion, decreasing glucagon, slowing gastric emptying, and increasing satiety 1
• SGLT2 inhibitors: prevent glucose reabsorption in the kidneys, causing glucose excretion in urine, which lowers blood sugar and leads to caloric loss 1

Dosing and Administration

• GLP-1 agonists: most are administered as weekly injections, except Rybelsus which is oral and Victoza/Saxenda which are daily 1
• SGLT2 inhibitors: taken orally once daily 1

Side Effects and Benefits

• GLP-1 agonists: side effects include nausea, vomiting, and diarrhea, while offering cardiovascular and renal benefits beyond glucose control and weight management 1
• SGLT2 inhibitors: may cause genital infections, urinary tract infections, and volume depletion, while also offering cardiovascular and renal benefits 1

From the Research

GLP-1 Receptor Agonists

• The following GLP-1 receptor agonists are used for diabetes and weight management:
  • Exenatide b.i.d. (twice daily) 2
  • Lixisenatide (once daily) 2
  • Liraglutide (once daily) 2, 3
  • Exenatide once weekly 2, 4
  • Dulaglutide (once weekly) 2, 3, 4
  • Albiglutide (once weekly) 2, 3
  • Semaglutide (once weekly or daily oral preparation) 2, 4, 5
• These medications have common mechanisms of action, including augmentation of hyperglycemia-induced insulin secretion, suppression of glucagon secretion, deceleration of gastric emptying, and reduction in calorie intake and body weight 2

SGLT2 Inhibitors

• The following SGLT2 inhibitors are used for diabetes and weight management:
  • Canagliflozin 6
  • Dapagliflozin 6
  • Empagliflozin 6
• These medications have been shown to improve glycaemic control, promote weight loss, and lower blood pressure, with added benefits of reducing urinary and genital tract infections 6

Comparison of GLP-1 Receptor Agonists and SGLT2 Inhibitors

• Both classes of medications have been shown to be effective in improving glycaemic control and promoting weight loss, but may have different mechanisms of action and side effect profiles 2, 6
• GLP-1 receptor agonists may have a greater effect on weight loss and cardiovascular risk markers, while SGLT2 inhibitors may have a greater effect on reducing blood pressure and urinary tract infections 2, 6