GLP-1 Agonists

GLP-1 agonists are a type of medication that people with type 2 diabetes can use to lower blood sugar levels.

How do GLP-1 agonists work?

GLP-1 is a hormone (a natural chemical in the body) that is produced in the small intestine. It stimulates insulin secretion (which then allows cells to take up glucose) and inhibits glucagon secretion (which prevents more glucose from going into the bloodstream) to lower blood sugar levels. GLP-1 also slows stomach emptying, meaning that less glucose from food is released into the bloodstream. GLP-1 agonist medications support the work of GLP-1 in the body.

Shorter-acting GLP-1s are particularly effective at lowering post-meal glucose spikes, whereas longer-acting GLP-1s have more balanced effects on lowering post-meal and fasting glucose levels.

Who uses GLP-1 agonists?

GLP-1 agonists are most often used by people with type 2 diabetes to manage blood sugar levels. GLP-1s can be taken alone, or with metformin or other diabetes drugs.

GLP-1s are not currently approved by the FDA for people with type 1 diabetes due to the increased risk of diabetic ketoacidosis (DKA). However, some healthcare professionals choose to prescribe GLP-1s off-label to those with type 1 diabetes.

What are the benefits?

GLP-1s are highly effective at lowering blood glucose and A1C levels. Often, GLP-1s are given with other medications as part of a combination treatment.
GLP-1s can lead to significant weight loss. Some GLP-1 drugs are sold as treatments for both diabetes and obesity. For example, Ozempic (diabetes drug) and Wegovy (obesity drug) both use a GLP-1 called semaglutide and differ only in dosage.
Some GLP-1s have been shown to lower the risk of heart disease and kidney disease.
GLP-1s by themselves have a low risk of hypoglycemia. However, hypoglycemia can become a serious risk if GLP-1s are taken alongside other medications that lower blood glucose, such as insulin.

What are the drawbacks?

Most GLP-1s are taken by injection. The only exception is Rybelsus, an oral medication (pill).
Common side effects include nausea, vomiting, and diarrhea. These generally decrease over time.
GLP-1s are more expensive than some other glucose-lowering medications, like sulfonylureas (SFUs) and metformin. Patient assistance programs exist to help people who meet eligibility criteria.