GLUCAGON-LIKE PEPTIDE 1 RECEPTOR AGONISTS FOR TYPE 2 DIABETES: A COMPREHENSIVE REVIEW OF HOW TO WEIGH THE OPTIONS, SELECT THE RIGHT PATIENTS, AND MAXIMIZE BENEFITS

A growing body of data, guideline recommendations, algorithms, and position papers support the use of glucagon-like peptide 1 (GLP-1) receptor agonists in type 2 diabetes (T2D), given their beneficial effects on glycemic control, weight, lipid parameters, and blood pressure, and low risk for hypoglycemia when used in patients who have not achieved glycemic goals with metformin and lifestyle interventions. Exciting new evidence continues to emerge showing the utility of certain GLP-1 receptor agonists to decrease incident cardiovascular (CV) outcomes and bolster glycemic control when combined with other antihyperglycemic therapies, including basal insulin. The recent availability of fixed-ratio GLP-1 receptor agonist and basal insulin coformulations-and a new, first-ever indication for the use of a GLP-1 receptor agonist (liraglutide) to reduce the risk of major adverse CV events (MACEs) in adults with T2D and established CV disease-increase options for improved care. In addition, semaglutide (another GLP-1 receptor agonist with positive CV outcomes data) received Food and Drug Administration approval in December 2017 with an indication to improve glycemic control in adults with T2D. These new developments and continuously emerging CV outcomes data should be considered in determining how GLP-1 receptor agonists may be best used in clinical practice. This Q&A presentation with two expert endocrinologists provides a pragmatic approach to inform the selection and use of GLP-1 receptor agonists based on the rapidly evolving evidence.