The effective management of diabetes involves adopting healthy lifestyle practices such as consuming nutritious, well-balanced foods, regularly exercising and good adherence to a medication regimen.
A typical medication regimen for diabetes management may include injectable insulins, as well as oral medicines like biguanides, sulphonylureas (SU), thiazolidinediones (TZD), dipeptidyl peptidase 4 (DPP-4) inhibitors and sodium-glucose co-transporter-2 (SGLT2) inhibitors.
Over the past decade, new therapies such as glucagon-like-peptide-1 receptor agonists (GLP-1 RAs) have been developed. Unlike other conventional therapies, GLP-1 RAs can now be administered once weekly, and offer more than just optimal glycaemic control. GLP-1 hormones are produced in the small intestine when we eat and signal the pancreas to produce the insulin required by the body to reduce blood sugar level to normal. GLP-1 also helps to slow down gastric emptying, preventing an after-meal sugar spike from occurring [1,2]. At the same time, the GLP-1 promotes fullness, which in turn prevents overeating and weight gain.
Unfortunately, in diabetes patients, the functions of GLP-1 are impaired, a phenomenon known as impaired incretin effect. The good news is this incretin impairment can be corrected by a GLP-1RA therapy. GLP-1 RAs mimic the action of natural GLP-1 hormones in the body. In addition, they provide supraphysiological concentrations of GLP-1 which allow diabetes patients to achieve not only good glycaemic control and healthy weight loss, some of them have cardiovascular benefits on blood pressure, the vascular endothelium, atherosclerosis progression and inflammation, myocardial ischemia, heart failure, and so on, which can confer protection against cardiovascular diseases (CVD).
A number of GLP-1 RAs have been introduced to the global pharmaceutical market over the last decade, and several more are in development. The tolerability, dosing frequency, administration requirements, and cost may vary between different agents within the class.
What Sets GLP1-RAs Apart From Other Diabetes Medications?
Like insulin and other anti-diabetic medications that are administered using injectables, GLP-1 RAs are administered as subcutaneous injections. However, as compared to conventional insulin regimens which may require multiple injections daily, innovations in GLP-1 RAs have progressed from being once daily to now once-weekly formulations. They are also available in multi-use or single-use, disposable pen devices. The less frequent injection schedule and ease of use of GLP-1 RA may offer the advantage of better adherence to treatment, which may also offer much convenience to both patients and caregivers. Unlike insulin, GLP-1RAs have low risk of hypoglycaemia owing to their glucose-dependent mode of actions.
Current global treatment guidelines for treating diabetes are now focusing on composite endpoints, with the goal of not only achieving glycaemic control but also minimising other conditions such as weight gain and hypoglycaemia. Newer GLP1-RAs such as semaglutide once-weekly have been proven to have higher efficacy and superiority in lowering HbA1c and reducing body weight as compared to other GLP-1RAs, without an increased risk of hypoglycaemia [3].Additionally, semaglutide once-weekly is also able to lower the risk of major CVD. This is evident from the results of a cardiovascular outcome trial known as SUSTAIN-6, which demonstrated that diabetes patients presented with established CVD or very high CV risk experienced a significantly reduced risk – close to 26% – of CVD-associated death, non-fatal myocardial infarction (MI) or non-fatal stroke [4].
Given the broader range of clinical benefits of GLP-1 RA, recent global guidelines by the American Diabetes Association (ADA) has also recommended GLP-1 RA as second line therapy after metformin in patients who are predominate with atherosclerotic CVD and chronic kidney disease, overweight/obese and more susceptible to hypoglycaemia [5].
Your doctor will be the best qualified source to guide and advise you on the best approach to manage your condition and the type of treatment most suitable to your needs. Early detection is also a key prevention measure, and whether you are at risk or is someone with diabetes or obesity, having regular screening and health checks can help to both detect and monitor your condition to help you achieve a better quality of life.
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