From the Guidelines
Patients starting GLP-1 receptor agonists should be closely monitored for gastrointestinal side effects, weight changes, blood glucose levels, and potential adverse reactions, with initial weekly check-ins for the first month, then monthly for three months, and quarterly thereafter, as supported by the recent study 1. When initiating GLP-1 receptor agonists, it is crucial to start with the lowest dose and titrate upward slowly to minimize side effects, as recommended in the study 1. The most common adverse effects of GLP-1 receptor agonists include nausea, vomiting, diarrhea, and constipation, which are dose-dependent and more frequent with short-acting drugs.
Key Monitoring Parameters
- Fasting and postprandial glucose levels
- HbA1c every three months until stable
- Weight at each visit
- Common side effects such as nausea, vomiting, diarrhea, and constipation
- Hydration status and potential need for anti-nausea medications
Special Considerations
- Patients with type 2 diabetes should be monitored for hypoglycemia, especially if combined with sulfonylureas or insulin, and adjust these medications as needed, as noted in the study 1.
- Kidney function should be evaluated periodically, particularly in patients with pre-existing renal impairment.
- Rare but serious adverse events such as pancreatitis (abdominal pain, vomiting) and thyroid issues should be watched for, as reported in the study 1. The therapeutic effects and side effect profile of GLP-1 agonists can be attributed to their mechanism of action, which includes enhancing glucose-dependent insulin secretion, suppressing glucagon, delaying gastric emptying, and promoting satiety, as discussed in the study 1.
From the FDA Drug Label
After initiation of OZEMPIC, observe patients carefully for signs and symptoms of pancreatitis (including persistent severe abdominal pain, sometimes radiating to the back and which may or may not be accompanied by vomiting) Patients with a history of diabetic retinopathy should be monitored for progression of diabetic retinopathy. Monitor renal function when initiating or escalating doses of OZEMPIC in patients reporting severe adverse gastrointestinal reactions. If a hypersensitivity reaction occurs, discontinue liraglutide injection; treat promptly per standard of care, and monitor until signs and symptoms resolve. Use caution when initiating or escalating doses of liraglutide injection in patients with renal impairment
Key Monitoring Recommendations for Patients on GLP-1:
- Monitor for signs and symptoms of pancreatitis
- Monitor patients with a history of diabetic retinopathy for progression
- Monitor renal function in patients with severe gastrointestinal reactions
- Monitor for hypersensitivity reactions
- Use caution in patients with renal impairment 2, 3
From the Research
Monitoring Patients on GLP-1 Receptor Agonists
When monitoring patients who are just starting GLP-1 receptor agonists, several factors should be considered:
- Glycemic control: GLP-1 RAs have been shown to effectively lower A1C levels 4, 5, 6, 7
- Weight management: GLP-1 RAs can aid in weight loss, which is beneficial for patients with type 2 diabetes 5, 6, 7
- Cardiovascular risk: Some GLP-1 RAs have been shown to reduce cardiovascular risk factors, such as blood pressure and lipid profiles 7, 8
- Gastrointestinal side effects: GLP-1 RAs can cause gastrointestinal side effects, such as nausea and diarrhea, which may be transient 5, 6
- Hypoglycemia risk: GLP-1 RAs have a low risk of hypoglycemia when used as monotherapy, but the risk may increase when used with insulin secretagogues or insulin 5, 6
Recommendations for Monitoring
Based on the available evidence, the following recommendations can be made for monitoring patients on GLP-1 receptor agonists:
- Regularly monitor A1C levels to assess glycemic control 4, 5, 6, 7
- Monitor weight and body mass index (BMI) to assess the effectiveness of GLP-1 RAs on weight management 5, 6, 7
- Monitor blood pressure and lipid profiles to assess the cardiovascular benefits of GLP-1 RAs 7, 8
- Monitor for gastrointestinal side effects and adjust treatment as needed 5, 6
- Monitor for hypoglycemia, especially when GLP-1 RAs are used with insulin secretagogues or insulin 5, 6