Are all glucagon-like peptide-1 receptor agonists equally safe and effective in patients with type 2 diabetes?

This study looked at 8 glucagon-like peptide-1 receptor agonists (GLP-1RAs) for the treatment of type 2 diabetes (T2D). They found that all 8 were more effective than placebo and there were no significant differences in safety.

GLP-1RA is a type of diabetic medication that works by increasing natural insulin release in the body.  There are a number of GLP-1RAs including semaglutide (Ozempic), exenatide (Byetta), liraglutide (Victoza), lixisenatide (Lyxumia), dulaglutide (Trulicity), and albiglutide (Tanzeum). Some are taken by mouth, some by injection, some weekly, some daily. It is not clear if they are all equally safe and effective in patients with T2D.

This study compared the results of 36 other studies involving a total of 11,126 patients with T2D. They compared the effects of 8 GLP-1RA drugs and formulations on weight and blood glucose control, and side effects. The drugs compared were albiglutide 30mg once weekly, dulaglutide 1.5mg once weekly, exenatide 10mcg twice a day, liraglutide 1.8mg once a day, lixisenatide 20mcg once a day, semaglutide 14mg once a day, semaglutide 1mg once weekly, and exenatide 2mg once weekly.   

All GLP-1RAs resulted in a reduction in HbA1c (a measurement of blood glucose control over the past 2-3 months), ranging from -0.56% to -1.51%, compared to placebo. All GLP-1RAs except albiglutide resulted in a reduction in weight, ranging from -0.76 kg to -4.27 kg, compared to placebo. The best results were seen with semaglutide 1mg once weekly, followed by semaglutide 14mg once a day, liraglutide 1.8mg once a day, exenatide 2mg once weekly, and lixisenatide 20mcg once a day.

There was no significant difference in complications between the medications. There was a higher occurrence of hypoglycemia (dangerously low blood glucose levels) with all medication except for albiglutide.

This studied showed that all 8 GLP-1RAs are effective at improving blood glucose control and reducing weight in patients with T2D.

The studies included in this study varied in treatment duration and treatment regimen. More studies are needed.