GLP-1 RAs have been described as a ‘paradigm shift’ in the way type 2 diabetes is managed
When it comes to the treatment of type 2 diabetes, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have often been considered well down the line of treatment options. But updated Australian guidelines are now recommending that clinicians consider them earlier, after, or in combination with, metformin to help patients lower their blood glucose levels.
Administered via injection, GLP-1 RAs work by mimicking the effects of the hormone GLP-1 produced in the body when eating, stimulating the pancreas to secrete insulin and reduce blood glucose levels. The GLP-1 RAs available on the Pharmaceutical Benefits Scheme (PBS) come in multiple forms, including semaglutide and dulaglutide, taken once weekly, and exenatide, which is taken twice daily. All GLP-1RAs are TGA indicated for use with other diabetes medications, including SGLT2is, and are PBS reimbursed for use together with metformin, sulfonylureas and insulin.
Comparing SGLT2s to GLP-1 RAs, while SGLT2is can be useful in reducing hospitalisation for heart failure, with some demonstrated CV benefit, they are generally less effective in lowering HbA1c and body weight. It is important that prescribers are aware of this important option in treatment of type 2 diabetes and discuss it with patients when HbA1c levels are not at target or, [if] patients have established cardiovascular disease [CVD] or a high risk of CVD.