Managing the multifaceted nature of type 2 diabetes using once‐weekly injectable GLP‐1 receptor agonist therapy

Abstract

What is known and objective As a highly prevalent chronic condition associated with complications and high mortality rates, it is important for pharmacists to have a comprehensive understanding of the impact of type 2 diabetes (T2D) and available treatment options. The use of injectable glucagon‐like peptide 1 receptor agonists (GLP‐1 RAs) is recommended as an effective and convenient treatment regimen for improving glycaemic control in individuals with T2D, with a good safety profile; however, the wider extent of its potential benefits often are unknown to clinical pharmacists. The objective of this article is to provide an overview of the impact of T2D on individuals and to discuss the multifaceted role of once‐weekly (QW) GLP‐1 RAs in addressing these challenges. Methods This is a narrative review of the published literature regarding the use of injectable GLP‐1 RAs in managing health complications in people with T2D. Results and discussion Recent findings reveal additional benefits of GLP‐1 RAs in managing T2D complications, including atherosclerotic cardiovascular (CV) disease, retinopathy, neuropathy, and nephropathy. Dulaglutide and semaglutide have been shown to provide additional CV benefit in patients at high risk of CV events compared with standard of care/placebo and may offer renal protection in patients with chronic kidney disease. Cost‐effectiveness studies, taking into consideration these different complications, have shown that QW GLP‐1 RAs were cost‐effective compared with other therapies. GLP‐1 RAs may also help to improve overall health‐related quality of life, reducing the risk of depression and 'diabetes distress', and limiting the risk of hypoglycaemia. What is new and conclusion From the literature, this appears to be the first review of the evidence supporting the multifaceted role of QW GLP‐1 RAs in T2D, with particular emphasis on their use in comorbid conditions, as well as associated potential financial and well‐being benefits. The results suggest that QW GLP‐1 RAs may be an attractive treatment option for improving glycaemic control in T2D, especially in individuals with (or at risk of) additional comorbidities or health complications.

Clinical Characteristics Associated with Adherence and Persistence in Patients with Type 2 Diabetes Mellitus Treated with Dulaglutide

“…Neuropathic comorbidities are known to complicate routine tasks of diabetes management (e.g., checking blood glucose level) because of exaggerated pain response [ 31 ]. In this sense, the once-weekly dosing of dulaglutide may reduce the frequency of such tasks in T2DM patients with baseline neuropathy [ 32 ], contributing to improved adherence and persistence. Another explanation is that patients with baseline neuropathy are more likely to have longer T2DM duration, greater disease severity, and more failed previous treatments, which could collectively heighten their awareness of health status and thus improve their adherence and persistence.…”

Case Report: Semaglutide-associated depression: a report of two cases

“…Since the first GLP-1 RA (exenatide twice daily) was approved in 2005 by U.S. Food and Drug Administration (FDA), a series of GLP-1 RAs have been on the market ( 1 ). Semaglutide, also a GLP-1 RA, got approval in 2017 by U.S. Food and Drug Administration (FDA)for the treatment of type 2 diabetes mellitus to control blood glucose (initiated at a dose of 0.25 mg once weekly for the first 4 weeks and the dose gradually increased to 1 mg once weekly) ( 2 ). Then in 2021, it was approved for weight loss by FDA.…”

The Real DAPSI: A Real-World Retrospective Study on Assessing the Efficacy and Safety of a Fixed-Dose Combination of Dapagliflozin and Sitagliptin in the Indian Population

“…Current guidelines recommend a multifaceted approach to type 2 DM (T2DM) management, including lifestyle modifications, oral anti-diabetic agents, and, if necessary, injectable therapies such as insulin or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) [3]. Despite the availability of various treatment options, achieving and maintaining glycemic control remains a challenge for many patients, with a substantial proportion failing to achieve target glycated hemoglobin (HbA1c) levels [4].…”

“…Dapagliflozin and sitagliptin are two anti-diabetic agents that work through different mechanisms to lower blood glucose levels. Dapagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that reduces renal glucose reabsorption, leading to increased urinary glucose excretion [3,6]. Sitagliptin, on the other hand, is a dipeptidyl peptidase-4 (DPP-4) inhibitor that increases the levels of active incretin hormones, which in turn stimulate insulin secretion and suppresses glucagon secretion.…”