What is the recommended approach for chronic Glucagon-like peptide-1 (GLP-1) receptor agonist use, such as liraglutide (Victoza) or semaglutide (Ozempic), in managing diabetes?

From the Guidelines

The recommended approach for chronic GLP-1 receptor agonist use in diabetes management involves starting with a low dose and gradually titrating upward to minimize gastrointestinal side effects, with semaglutide (Ozempic) being a preferred option due to its demonstrated cardiovascular benefits 1. For semaglutide (Ozempic), start with 0.25 mg once weekly for four weeks, then increase to 0.5 mg weekly, with further titration to 1 mg or 2 mg weekly based on glycemic response, as recommended by recent guidelines 1. These medications should be administered subcutaneously, preferably at the same time each day or week. Patients should be monitored for nausea, vomiting, and diarrhea, which typically improve over time, and dose adjustments may be necessary for patients with renal impairment, with caution advised in those with a history of pancreatitis or severe renal impairment 1. GLP-1 receptor agonists work by enhancing glucose-dependent insulin secretion, suppressing glucagon release, slowing gastric emptying, and promoting satiety, making them particularly beneficial for patients with type 2 diabetes who also need weight management. They can be used as monotherapy or in combination with other diabetes medications, including insulin. Regular monitoring of blood glucose levels, HbA1c, and kidney function is essential during treatment. Some key considerations for the use of GLP-1 receptor agonists include:

• Starting with a low dose and gradually titrating upward to minimize gastrointestinal side effects
• Monitoring for nausea, vomiting, and diarrhea, and adjusting the dose as needed
• Using caution in patients with a history of pancreatitis or severe renal impairment
• Regularly monitoring blood glucose levels, HbA1c, and kidney function during treatment
• Considering the use of semaglutide (Ozempic) due to its demonstrated cardiovascular benefits 1.

From the FDA Drug Label

OZEMPIC is an injectable prescription medicine used: • along with diet and exercise to improve blood sugar (glucose) in adults with type 2 diabetes mellitus. Use OZEMPIC exactly as your healthcare provider tells you to OZEMPIC is injected under the skin (subcutaneously) of your stomach (abdomen), thigh, or upper arm. Use OZEMPIC 1 time each week, on the same day each week, at any time of the day

The recommended approach for chronic GLP-1 receptor agonist use, such as semaglutide (Ozempic), in managing diabetes is to use it once a week , on the same day each week, at any time of the day, along with diet and exercise to improve blood sugar in adults with type 2 diabetes mellitus 2. Key points to consider:

• Dose administration: Inject OZEMPIC under the skin (subcutaneously) of your stomach (abdomen), thigh, or upper arm.
• Dose frequency: Use OZEMPIC 1 time each week, on the same day each week, at any time of the day.
• Importance of medical supervision: Use OZEMPIC exactly as your healthcare provider tells you to.
• Lifestyle modifications: OZEMPIC should be used along with diet and exercise to improve blood sugar in adults with type 2 diabetes mellitus.

From the Research

Chronic GLP-1 Use

• The recommended approach for chronic Glucagon-like peptide-1 (GLP-1) receptor agonist use, such as liraglutide (Victoza) or semaglutide (Ozempic), in managing diabetes involves considering the patient's individual risk for cardiovascular and kidney outcomes 3.
• GLP-1 receptor agonists are recommended as the preferred first injectable glucose-lowering therapy for type 2 diabetes, even before insulin treatment, due to their effectiveness in reducing HbA1c, body weight, and cardiovascular risk 4.
• The choice of GLP-1 receptor agonist depends on the patient's specific needs and medical history, with options including short-acting agents (exenatide b.i.d., lixisenatide) and long-acting agents (liraglutide, once-weekly exenatide, dulaglutide, albiglutide, and semaglutide) 4, 5.

Benefits and Harms

• GLP-1 receptor agonists have been shown to reduce the risk of major cardiovascular events, all-cause death, and kidney failure in patients with type 2 diabetes and chronic kidney disease 6, 7.
• The medications also have benefits in terms of weight loss and blood pressure reduction, and may have renoprotective effects 7.
• However, GLP-1 receptor agonists may have gastrointestinal side effects, and their use is contraindicated in patients with a history of medullary thyroid cancer or pancreatitis of a known cause 7.

Clinical Practice Guidelines

• The use of GLP-1 receptor agonists in adults with type 2 diabetes should be guided by risk-stratified recommendations, taking into account the patient's individual risk for cardiovascular and kidney outcomes 3.
• For patients with established cardiovascular disease or chronic kidney disease, a strong recommendation is made for starting SGLT-2 inhibitors, and a weak recommendation for starting GLP-1 receptor agonists 3.
• Clinicians should consider the balance of benefits, harms, and practical issues for each patient, and use credible risk calculators and decision aids to support informed treatment choices 3.