Glucagon-like peptide-1 (GLP-1) is an incretin hormone involved in glucose regulation. Made in the intestines and released in response to the rise in glucose from eating, GLP-1 plays a critical role in glucose homeostasis by increasing insulin production and suppressing glucagon release. Additionally, GLP-1 slows gastric emptying and contributes to satiety. The combination of these factors contributes to glycemia, particularly following meals. Activity of GLP-1, much like insulin, is impaired in patients with type 2 diabetes (T2DM) (Shaikh & Goldman, 2016). However, the advent of GLP-1 receptor agonists (GLP-1 RA) to the market in 2005 provided the option to restore this function and better refine glycemic management for people with T2DM
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They may be considered as a second-line of therapy in combination with metformin or a third-line option in combination with metformin and either a sulfonylurea (SU), thiazolidinediones (TZD), or basal insulin. GLP-1s may also be utilized as a first line therapy when metformin, the standard first-line option, is either contraindicated or not tolerated (ADA, 2016; Garber et al., …show more content…
To that end albiglutide, dulaglutide, exenatide XR, and liraglutide are reported to have less of an impact on gastric emptying and more of an impact on insulin secretion so they may be preferred in patients that would benefit from reduction of both fasting and post prandial glucose values. Exenatide is associated with more significant delays in gastric emptying and would therefore be a good choice when targeting post-prandial glucose levels. Adding a GLP-1 RA in this instance instead of prandial insulin would decrease the burden on the patient, while also minimizing the risk for hypoglycemia. Additionally, GLP-1 RAs are easier to titrate and teach (Anderson & Trujillo,
They may be considered as a second-line of therapy in combination with metformin or a third-line option in combination with metformin and either a sulfonylurea (SU), thiazolidinediones (TZD), or basal insulin. GLP-1s may also be utilized as a first line therapy when metformin, the standard first-line option, is either contraindicated or not tolerated (ADA, 2016; Garber et al., …show more content…
To that end albiglutide, dulaglutide, exenatide XR, and liraglutide are reported to have less of an impact on gastric emptying and more of an impact on insulin secretion so they may be preferred in patients that would benefit from reduction of both fasting and post prandial glucose values. Exenatide is associated with more significant delays in gastric emptying and would therefore be a good choice when targeting post-prandial glucose levels. Adding a GLP-1 RA in this instance instead of prandial insulin would decrease the burden on the patient, while also minimizing the risk for hypoglycemia. Additionally, GLP-1 RAs are easier to titrate and teach (Anderson & Trujillo,