From the Guidelines
GLP-1 agonists are a preferred choice for managing type 2 diabetes due to their efficacy in reducing HbA1c levels, low risk of hypoglycemia, and association with weight loss, although they can lead to emergency room visits due to gastrointestinal side effects, pancreatitis, and allergic reactions. The most common reasons for ER visits include severe gastrointestinal symptoms, such as persistent vomiting, severe abdominal pain, or dehydration, which can be minimized by starting with the lowest dose and gradually increasing as tolerated, staying well-hydrated, eating smaller meals, and avoiding high-fat foods 1. Patients experiencing symptoms like severe abdominal pain, persistent vomiting, signs of dehydration, or allergic reactions should seek immediate medical attention. GLP-1 receptor agonists have been shown to reduce albuminuria and slow eGFR decline, and are preferred agents for patients with type 2 diabetes and chronic kidney disease, with benefits including reduced risk of major adverse cardiovascular events and kidney disease progression 1.
Some key points to consider when prescribing GLP-1 agonists include:
- Starting with the lowest dose and gradually increasing as tolerated to minimize gastrointestinal side effects
- Monitoring patients for signs of dehydration, pancreatitis, and allergic reactions
- Considering the use of GLP-1 receptor agonists in patients with type 2 diabetes and chronic kidney disease to reduce kidney disease progression and cardiovascular risk
- Being aware of the potential for increased heart rate and injection site reactions, although these are typically mild and transient 1.
Overall, the benefits of GLP-1 agonists in managing type 2 diabetes and reducing cardiovascular and kidney disease risk make them a valuable treatment option, although careful monitoring and patient education are necessary to minimize the risk of adverse effects.
From the Research
GLP-1 Agonist Visits
- GLP-1 agonists, such as semaglutide and liraglutide, are used to treat type 2 diabetes and obesity 2
- These agents have demonstrated significant improvements in glucose control and weight loss, but are associated with adverse events such as gastrointestinal disturbances, pancreatitis, and biliary disease 2, 3
- The risk of pancreatitis with GLP-1 agonist use is a concern, but studies have shown that the risk is not significantly increased 3
- GLP-1 agonists have been shown to have a favorable risk/benefit profile, with benefits including improved glycemic control, weight loss, and cardiovascular risk reduction 4, 5
- Real-world evidence suggests that GLP-1 agonists are effective for weight loss, but may have lower efficacy and higher discontinuation rates compared to clinical trials 6
Adverse Events
- Common adverse events associated with GLP-1 agonist use include gastrointestinal disturbances, such as nausea, vomiting, and diarrhea 2, 6
- Pancreatitis and biliary disease are potential risks associated with GLP-1 agonist use, but the risk is not significantly increased 3
- Hypoglycemia may occur when GLP-1 agonists are used with sulfonylureas or insulin 2
- Diabetic retinopathy complications may be increased with GLP-1 agonist use, particularly in patients also treated with insulin 5
Clinical Use
- GLP-1 agonists are recommended as a first-line injectable therapy for type 2 diabetes, due to their efficacy and safety profile 4
- GLP-1 agonists may be used in combination with basal insulin for improved glycemic control 4
- Real-world evidence suggests that GLP-1 agonists are effective for weight loss, but may require careful consideration of individual patient factors, such as adherence and side effect management 6