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. The most common reasons for ER visits include severe gastrointestinal symptoms such as persistent vomiting, dehydration, and severe abdominal pain 1. These medications work by slowing gastric emptying and reducing appetite, which can cause nausea, vomiting, and diarrhea, especially when first starting treatment or after dose increases. To minimize the risk of ER visits, patients should start with the lowest dose and gradually increase as tolerated, stay well-hydrated, eat smaller meals, and avoid fatty or spicy foods.
Some key points to consider when prescribing GLP-1 agonists include:
- They have been shown to reduce albuminuria and slow eGFR decline in patients with chronic kidney disease 1
- They are associated with a lower risk of hypoglycemia and weight gain compared to insulin therapy 1
- They can cause nausea, vomiting, and diarrhea in 15-20% of patients, but these symptoms are usually tolerable with dose titration and abate over time 1
- Healthcare providers should counsel patients about these potential side effects before starting treatment and provide clear guidance on when to seek emergency care
In terms of specific GLP-1 agonists, semaglutide, dulaglutide, and liraglutide have been shown to have cardiovascular and CKD benefits, making them preferred agents 1. However, it's essential to consider the individual patient's needs and medical history when selecting a GLP-1 agonist. If experiencing severe symptoms like persistent vomiting for more than 24 hours, signs of dehydration, or severe abdominal pain, patients should seek immediate medical attention. In rare cases, GLP-1 agonists can cause more serious complications like pancreatitis or severe allergic reactions, which require immediate medical intervention.
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 hypersensitivity reactions 2
- The risk of pancreatitis with GLP-1 receptor agonists is a concern, but a study found that the use of GLP-1 RAs did not increase the risk of pancreatitis in a comorbidity-free subgroup of type 2 diabetes patients 3
- GLP-1 RAs have been shown to have cardiovascular benefits, including reducing the risk of acute myocardial infarction or stroke and associated mortality 4
- Real-world evidence on the utilization and effectiveness of GLP-1RA-based weight-loss therapies suggests that they can be effective, but are often associated with high discontinuation rates and gastrointestinal side effects 5
- Semaglutide, a GLP-1 receptor agonist, has been shown to have cardiovascular benefits and is available as a monotherapy in both subcutaneous and oral dosage forms 6
Adverse Events
- Common adverse events associated with GLP-1 agonists include gastrointestinal disturbances, such as nausea, vomiting, diarrhea, and abdominal pain 2
- Pancreatitis and biliary disease may also occur, although the risk of pancreatitis has been found to be lower in some studies 2, 3
- Hypersensitivity reactions, including injection site reactions and anaphylaxis, have been reported 2
- Renal adverse events are most commonly associated with severe gastrointestinal losses 2
Clinical Use
- GLP-1 agonists are recommended as the preferred first injectable glucose-lowering therapy for type 2 diabetes, even before insulin treatment 4
- They can be combined with basal insulin in either free- or fixed-dose preparations 4
- GLP-1 RAs may also help prevent renal complications of type 2 diabetes 4
- Real-world evidence suggests that GLP-1RA-based weight-loss therapies can be effective, but require careful consideration of individual patient factors, such as the ability to stick to treatment plans and manage side effects 5