From the Guidelines
GLP-1 receptor agonists are primarily indicated for type 2 diabetes management and weight loss in patients with obesity, with a focus on improving glycemic control, reducing cardiovascular risk, and promoting weight loss. The clinical indication for GLP-1s includes improving glycemic control in adults with type 2 diabetes, reducing the risk of major adverse cardiovascular events in adults with type 2 diabetes and established cardiovascular disease, and weight loss in patients with obesity 1. Some of the key medications in this class include semaglutide (Ozempic, Wegovy), liraglutide (Victoza, Saxenda), dulaglutide (Trulicity), and tirzepatide (Mounjaro, Zepbound), which work by mimicking the incretin hormone GLP-1 to stimulate insulin secretion, suppress glucagon release, slow gastric emptying, and increase satiety 1. For diabetes management, GLP-1s are typically prescribed when metformin alone is insufficient to achieve glycemic targets, with starting doses that are gradually titrated to minimize gastrointestinal side effects 1. In terms of weight management, higher doses of GLP-1s are often used in patients with BMI ≥30 kg/m² or ≥27 kg/m² with weight-related comorbidities, with studies showing significant weight loss and improvement in weight-related comorbidities 1. It's also important to note that GLP-1s offer additional cardiovascular benefits, particularly for patients with established cardiovascular disease, and may provide renal protection 1. Common side effects of GLP-1s include nausea, vomiting, and diarrhea, which typically improve over time, and contraindications include personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2, with caution advised in those with history of pancreatitis 1.
Key points to consider when prescribing GLP-1s include:
- Gradually titrating the dose to minimize gastrointestinal side effects
- Monitoring for signs of pancreatitis and thyroid cancer
- Considering the patient's cardiovascular risk profile and weight status when selecting a medication
- Educating patients on the importance of long-term use for sustained weight loss and cardiovascular benefits 1.
Overall, GLP-1s are a valuable treatment option for patients with type 2 diabetes and obesity, offering improved glycemic control, weight loss, and cardiovascular benefits, with a favorable safety profile when used appropriately 1.
From the FDA Drug Label
INDICATIONS AND USAGE OZEMPIC is a glucagon-like peptide 1 (GLP-1) receptor agonist indicated as: • an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus (1). • to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus and established cardiovascular disease (1)
INDICATIONS AND USAGE TRULICITY® is a glucagon-like peptide-1 (GLP-1) receptor agonist indicated (1): As an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients 10 years of age and older with type 2 diabetes mellitus. To reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus who have established cardiovascular disease or multiple cardiovascular risk factors.
The clinical indication for GLP-1s is:
- Improving glycemic control in adults with type 2 diabetes mellitus as an adjunct to diet and exercise.
- Reducing the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus and established cardiovascular disease or multiple cardiovascular risk factors. 2, 3, 2
From the Research
Clinical Indications for GLP-1s
The clinical indications for GLP-1 receptor agonists (GLP-1 RAs) are primarily focused on the treatment of type 2 diabetes mellitus (T2DM) 4, 5, 6, 7, 8.
- Type 2 Diabetes Mellitus (T2DM): GLP-1 RAs are used to improve glycemic control, reduce body weight, and decrease the risk of cardiovascular events in patients with T2DM 4, 5, 6, 7, 8.
- Cardiovascular Risk Reduction: Long-acting GLP-1 RAs have been shown to reduce the risk of major adverse cardiovascular events, such as myocardial infarction, stroke, and cardiovascular mortality, in patients with established cardiovascular disease or at high risk of cardiovascular events 4, 8.
- Renal Protection: GLP-1 RAs may also have a role in preventing renal complications of T2DM, although further research is needed to confirm this benefit 4.
Patient Selection
The choice of GLP-1 RA should be individualized based on patient characteristics, such as renal function, cardiovascular risk, and personal preferences 6, 7, 8.
- Patient Preferences: Considerations include dosing frequency, administration route, and potential side effects 6, 7.
- Cardiovascular Risk: Patients with established cardiovascular disease or at high risk of cardiovascular events may benefit from long-acting GLP-1 RAs 4, 8.
- Renal Function: GLP-1 RAs may be used in patients with mild to moderate renal impairment, but caution is advised in those with severe renal impairment 6, 8.