Clinical Pearls

Thank you for attending the CME Breakfast Symposium, Applying the Evidence for GLP-1 Receptor Agonists in Type 2 Diabetes:  Practice Perspectives, on Friday, March 6, 2015, in San Diego, CA.

This activity was presented by the Endocrine Society and held during the Society’s 2015 Annual Meeting. The program was produced by Haymarket Medical Education and supported by an educational grant from AstraZeneca.

Below are the key take-home points from this educational activity:

1. A number of approaches exist for the intensification of T2DM therapy when 2 or more oral agents have failed to adequately control blood glucose.

  • Additional oral agents
  • Add basal insulin
  • Add incretin injection

2. All GLP-1 receptor agonists (RAs) have gastrointestinal (GI)―as well as islet―effects.

  • Both short- and long-acting formulations are associated with weight loss.
  • Short-acting GLP-1 RAs have strong effects on postprandial glucose.
  • Long-acting GLP-1 RAs better control fasting plasma glucose levels, leading to greater overall reductions in A1C.

3. The most common adverse events related to GLP-1 RA therapy are GI side effects (eg, nausea) and injection-site reactions.

  • Incidence of nausea varies by therapy.
    • Nause tends to be transient and decrease more rapidly in those taking long-acting formulations.

4. It is currently unknown whether GLP-1 RAs cause thyroid C-cell tumors.

  • Patients taking these therapies should be counseled on the risks and symptoms of thyroid tumors.

5. While a controversial FDA analysis showed an increased risk of pancreatitis with GLP-1 RA use, no increased risk has been found via multiple analyses of health care claims data.

6. Retrospective analysis shows no increased risk for major adverse cardiovascular (CV) events with GLP1-RAs.

  • Several large CV trials are ongoing.

7. A recent meta-analyses on patient preferences showed that individuals with T2DM rank efficacy over minor adverse effects when selecting a therapy.

8. When metformin and lifestyle interventions fail, the increasing utility  of GLP-1 RA therapy is now strongly supported by data.

  • Evidence from large, randomized clinical trials shows that a GLP-1 RA can be as effective in lowering A1C as basal insulin, with the advantage of inducing weight loss. 
  • Safety and efficacy data also support the use of basal insulin in combination with a GLP-1 RA to enhance lowering of A1C.