GLP-1 receptor agonists are peptide hormones that mimic the effects of endogenous GLP-1, a hormone released by the intestine after eating. GLP-1 plays an important role in glucose control by stimulating insulin secretion, suppressing glucagon release, and slowing down gastric emptying. It also contributes to a feeling of satiety or fullness.
These intestinal hormones act as incretins, increasing insulin secretion in a glucose-dependent manner. GLP-1 receptor agonists capitalize on this mechanism of action to achieve glycemic control in type 2 diabetes. They represent the first class of anti-diabetic drugs designed to stimulate and activate the body’s own glucose regulatory system.
Mechanism of Action
GLP-1 receptor agonists exert their effects by binding to and activating GLP-1 receptors primarily located in the pancreas, stomach, small intestine, and brain.
In the pancreas, they stimulate insulin secretion from beta cells when blood glucose levels are high. At the same time, they suppress glucagon release by alpha cells, helping lower glucose levels.
In the stomach and small intestine, they slow down gastric emptying and increase feelings of satiety, thereby helping with weight loss.
Finally, in the brain, they have been shown to regulate appetite and food intake by activating regions involved in appetite control.
Efficacy in Glycemic Control and Weight Loss
Clinical trials have demonstrated the superior glucose-lowering ability of GLP-1 receptor agonists compared to other oral anti-diabetic agents. Hemoglobin A1c (HbA1c), an indicator of blood sugar control, is typically reduced by 0.5-2% with their use.
Weight loss of up to 10 pounds or more has also been observed with certain GLP-1 receptor agonists like liraglutide and semaglutide. This additional benefit provides an advantage over other classes of diabetes medications that are typically weight neutral.
Safety Profile and Cardiovascular Effects
Overall, GLP-1 receptor agonists have been found to have an excellent safety profile. Nausea is the most commonly reported side effect, usually dissipating after a few days or weeks of therapy.
Large cardiovascular outcome trials have also demonstrated reductions in major adverse cardiac events such as heart attack and stroke with liraglutide and semaglutide use. This offers an additional layer of protection besides glycemic control for people with diabetes who are at high risk for cardiovascular disease.
Available GLP-1 Receptor Agonist Options
Currently, there are several GLP-1 receptor agonists approved for clinical use. They differ in their frequency of administration and dosage forms:
– Exenatide (Byetta): Injected twice daily. Was one of the first GLP-1 receptor agonists approved.
– Liraglutide (Victoza): Injected once daily. Associated with more weight loss than exenatide and available in higher doses.
– Dulaglutide (Trulicity): Injected once weekly. Convenient dosing and comparable efficacy to liraglutide.
– Semaglutide (Ozempic/RyBelsus): Administered once weekly as an injection or daily as an oral tablet. Most data on cardiovascular benefits. Associated with greater weight loss than other agents.
– Lixisenatide (Adlyxin): Injected once daily before meals. Associated with some weight loss.
Choosing the Right Agent
GLP-1 Receptor Agonist therapy offers several benefits beyond glycemic control alone. However, not all agents may be suitable or preferred for every individual. Factors like dosing frequency, administration route, insurance coverage, and out-of-pocket costs, as well as efficacy, side effects, and cardiovascular protection need to be considered when deciding on the right treatment option. Proper patient education and shared decision making with healthcare providers is essential for optimal outcomes.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
