A New Class of Medication for Type 2 Diabetes Treatment

Glucagon-like peptide-1 (GLP-1) receptor agonists are becoming increasingly popular in the treatment of type 2 diabetes mellitus. Do you have type 2 diabetes or have you recently been prescribed a GLP-1 medication? Read this article for all the information you need about this relatively new class of medications.

Key takeaways:
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    GLP-1 receptor agonists stimulate the body to produce more insulin to reduce blood glucose levels.
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    They are available in weekly, daily, and twice-daily injections, as well as an oral pill form.
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    The most common side effects include nausea, vomiting, diarrhea, abdominal pain, and constipation.
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    When picking the best one for you, consider your prescription coverage, ability to administer injections, and your preference on dosing frequency.

Glucagon-like peptide-1 (GLP-1) receptor agonists

There are six medications available:

  • Semaglutide (Ozempic, Rybelsus)
  • Exenatide (Byetta, Bydureon)
  • Dulaglutide (Trulicity)
  • Liraglutide (Victoza)
  • Lixisenatide (Adlyxin, Lyxumia)

Why are they used?

GLP-1 receptor agonists work by mimicking the effects of the natural hormone, glucagon-like peptide 1 (GLP-1). Similar to GLP-1, these medications stimulate the body to produce more insulin in response to food intake. Helping to lower blood sugar levels in diabetics and achieve adequate glucose control (improved hemoglobin A1c levels).

Additionally, these medications slow the emptying of the stomach making you feel fuller sooner. This can reduce the amount of food you consume which ultimately can lead to weight loss.

These medications can also safely be used with other diabetic medications (ie. metformin, insulin) to improve glucose control.

What are the side effects?

The most common side effects associated with GLP-1 receptor agonists include nausea, vomiting, diarrhea, abdominal pain, and constipation. Injection site reactions have been reported with injectable forms.

Hypoglycemia (low blood sugar) can occur infrequently when taking GLP-1 receptor agonists. However, if they are paired with other diabetic medications the risk of hypoglycemia significantly increases. Therefore, it is important to always monitor your blood sugar carefully when starting these medications.

If you experience the sudden onset of severe abdominal pain as this could be a sign of the rare side effect of pancreatitis. Also, if you have a family or personal history of thyroid medullary cancer or multiple endocrine neoplasias, you should not take these medications.

What to do if I miss a dose?

MedicationBrand nameWhat to do if you miss a dose?
Semaglutide (long-acting injection)OzempicAdminister as soon as possible if within 5 days of a missed dose. For More than 5 days, skip the dose and administer the next scheduled dose.
Semaglutide (oral pill)RybelsusSkip the missed dose and take the next day's dose as prescribed.
Exenatide (twice daily injection)
ByettaSkip the dose and take the next dose at the prescribed time. Do not take more or double the recommended dose.
Exenatide (weekly injection)BydureonAdminister as soon as possible if within 5 days of a missed dose. For More than 5 days, skip the dose and administer the next scheduled dose.
DulaglutideTrulicityAdminister as soon as possible if more than 3 days from the next dose. If less than 3 days, skip the dose and administer the next scheduled dose.
LiraglutideVictozaAdminister missed dose as soon as possible, then take the next day’s dose at a regularly scheduled time.
LixisenatideAdlyxinAdminister missed dose one hour before the next meal.

How to choose one in this category?

All GLP-1 agonists have comparable efficacy in terms of lowering blood glucose levels. In addition, many of them provide the extra benefit of lowering cardiovascular risks.

Given these similarities, many times the drug choice may come down to which medication is covered by your insurance. This will ensure an affordable, consistent use and save money over non-formulary medications.

In addition, one should pick the medication based on their preferences such as daily vs weekly dosing or injection vs oral forms. Deciding what works best for you will ensure better compliance and improved results.

How are they different?

Semaglutide is the only medication that comes in an oral pill. All other GLP-1 medications are injectable and require subcutaneous injections. Therefore, if it is difficult to administer an injection or prefer not to use an injectable medication, then semaglutide is the best one for you.

Semaglutide, exenatide, and dulaglutide are available in long-acting forms and only require an injection once a week. These longer-acting medications are better at reducing fasting glucose levels and Hgb A1c levels when compared to the short-acting forms. Additionally, the longer-acting forms have a more significant reduction in body weight.

Short-acting medications (liraglutide, lixisenatide, and exenatide) are better at slowing the emptying of the stomach and at reducing glucose levels after eating. However, these medications cause more nausea than the longer-acting forms.

Glucagon-like peptide 1 receptor agonists have provided a significant advancement in the treatment of type 2 diabetes. However, their effectiveness is considered comparable overall but they do have some important differences. Therefore, it is important to consider these differences in addition to your prescription coverage when deciding what one is best for you.

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