Routine Testing Prior to Starting GLP-1 RA Medications
No specific routine blood tests or imaging studies are required before initiating GLP-1 RA therapy in patients with type 2 diabetes. 1
Essential Pre-Treatment Assessment
Eye Examination (Critical Requirement)
- Patients must undergo appropriate, guideline-recommended eye examinations before starting therapy if not completed within the last 12 months 1
- This is particularly important for dulaglutide and injectable semaglutide due to potential risk of diabetic retinopathy complications 1
- Semaglutide specifically has been associated with increased risk of diabetic retinopathy complications, predominantly in patients with prior history of proliferative retinopathy 1
Clinical Contraindications to Assess
- Avoid GLP-1 RAs in patients with diabetic gastroparesis or active gallbladder disease 1
- Screen for history of pancreatitis, as GLP-1 RAs may increase risk of gallbladder disease including acute cholecystitis 1
- Assess for severe renal impairment or end-stage renal disease, particularly for liraglutide and semaglutide 1
Medication Adjustments Before Initiation
Discontinue Conflicting Medications
- Discontinue DPP-4 inhibitors before starting GLP-1 RA therapy 1
- These medications work through the same GLP-1 signaling pathway and have not been approved for concurrent use 1
Hypoglycemia Risk Mitigation
- If HbA1c is well-controlled at baseline or patient has history of frequent hypoglycemic events, wean or stop sulfonylurea 1
- For patients taking insulin, consider modestly reducing total daily insulin dose by up to 20% when starting therapy 1
- Instruct patients to more closely monitor glucose at home for the first 4 weeks of therapy 1
- Consider discontinuing any glinide medication 1
Monitoring Strategy (Not Pre-Treatment Testing)
Post-Initiation Monitoring
- Monitor blood glucose more frequently during the first 4 weeks, especially if on insulin, sulfonylurea, or glinides 1
- No specific laboratory monitoring is required for GLP-1 RA therapy itself 1
Common Pitfalls to Avoid
- Do not delay GLP-1 RA initiation waiting for unnecessary laboratory tests or imaging studies 1
- The only mandatory pre-treatment assessment is the eye examination if not done within 12 months 1
- Do not forget to discontinue DPP-4 inhibitors, as this is a critical medication interaction 1
- Do not fail to reduce insulin or sulfonylurea doses proactively, as this significantly increases hypoglycemia risk 1
- Ensure patients understand that transient nausea is common and can be minimized by starting at the lowest dose, up-titrating gradually, and eating smaller portions 1