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GLP-1 Agonists

How they work: GLP-1 is a hormone produced in the small intestine that stimulates insulin secretion and inhibits glucagon secretion, thereby lowering blood sugar. Shorter-acting agonists of the GLP-1 receptor are particularly effective at lowering post-meal glucose spikes, whereas longer-acting GLP-1 agonists have more balanced effects on lowering post-meal and fasting glucose levels.

Who Uses Them: GLP-1 agonists are most often used by people with type 2 diabetes who have inadequate blood glucose control with just metformin and/or other oral drugs. They can be taken alone, or alongside metformin and/or other diabetes drugs. They have stronger efficacy than DPP-4 inhibitors but also increased side effects, particularly nausea.

In-Depth Article:

​The GLP-1 Agonist Class – An article describing the effects of the GLP-1 agonist class of drugs, plus a section on DPP-4 inhibitors.

GLP-1 Agonists: From 2 Daily Injections to 1 Per Week and Beyond – A review of how far this class of drugs has come.

Approved Drugs:

Pros

Cons

  • Relatively low risk of hypoglycemia

  • Strong efficacy/A1c reduction

  • Weight loss (quite strong in some people)

  • Other possible benefits (beta cell preservation, cardiovascular benefit) being investigated

  • Delivered by injection * (once or twice daily, or weekly)

  • Nausea/gastrointestinal side effects, generally decreasing over time

  • More expensive than sulfonylureas/metformin

  • Possibility of a slight association with pancreatitis (still being studied)

* Rybelsus is an oral medication (pill) and is not injected

Last updated: October 24, 2019