Practical guide: Glucagon-like peptide-1 and dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists in diabetes mellitus

Abstract

In 2005, exenatide became the first approved glucagon-like peptide-1 receptor agonist (GLP-1 RA) for type 2 diabetes mellitus (T2DM). Since then, numerous GLP-1 RAs have been approved, including tirzepatide, a novel dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RA, which was approved in 2022. This class of drugs is considered safe with no hypoglycemia risk, making it a common second-line choice after metformin for treating T2DM. Various considerations can make selecting and switching between different GLP-1 RAs challenging. Our study aims to provide a comprehensive guide for the usage of GLP-1 RAs and dual GIP and GLP-1 RAs for the management of T2DM.

Keywords: Glucagon-like peptide-1 receptor agonist; Diabetes mellitus; Metabolic syndrome; Dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist; Clinical practice; Endocrinology

Core Tip: Various glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are available for the management of type 2 diabetes mellitus including short-acting and long-acting injectables as well as one agent as an oral tablet. Furthermore, dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 RAs have now emerged as the newest addition to the long-acting injectables. With the availability of various options, the complexity of choosing, titrating, and switching between agents, especially in certain patient populations, has become increasingly challenging. We aim to provide a comprehensive practical clinical guide for practitioners regarding GLP-1 RA and dual GIP and GLP-1 RA use in everyday clinical practice.