Are glucagon-like peptide-1 receptor agonists an effective treatment option for type 2 diabetes?

This study explored whether glucagon-like peptide-1 receptor agonists (GLP-1RAs) were effective in treating type-2 diabetes. The authors concluded that all GLP-1RA’s were effective and that the type of GLP-1RA chosen could be tailored to a patient’s specific needs.

Insulin is a hormone which controls blood-sugar levels. Patients with type-2 diabetes (T2D) do not produce enough insulin or are resistant to insulin. One potential treatment option are GLP-1RAs. Several GLP-1RAs exist, with varying effects. It is not clear whether one GLP-1RA is more effective than others.

This study assessed the effectiveness of eight GLP-1RAs in controlling both blood sugar and other health factors (such as blood pressure and weight loss). It also assessed the potential side effects.

The results of 34 trials (including a total 14,464 patients) were analyzed. The GLP-1RAs included were either “short-acting” (twice-daily exenatide [Byetta] or lixisenatide [Adlyxin]) or “long-acting” (once-weekly liraglutide [Victoza]; albiglutide [Tanzeum]; dulaglutide [Trulicity]; exenatide [Bydureon]; semaglutide; and taspoglutide). The effects of these medicines were compared with a placebo (substance with no effect), as well as with each other.

There were no notable differences in effects between the two short-acting agents, as well as between the six long-acting agents. All GLP-1RAs reduced HbA1c (average blood glucose over 3 months) and fasting blood glucose (glucose levels after a period without food or drink) compared to placebo. All GLP-1RAs except for albiglutide also reduced weight and increased the risk of hypoglycemia (dangerously low blood pressure) compared to placebo. All GLP-1RAs (except dulaglutide and taspoglutide) decreased systolic blood pressure (the measure of blood flow as the heart contracts).

Three long-acting agents (dulaglutide, liraglutide and once-weekly exenatide) were significantly better at controlling blood glucose compared to twice-daily exenatide. Albiglutide was associated with the lowest risk of nausea and diarrhea. Once-weekly exenatide had the lowest risk of vomiting.

This study concluded that the GLP-1RAs reviewed were all effective at reducing blood sugar levels. The study also concluded that intensity of the potential side-effects (i.e. nausea, diarrhea, vomiting) varied depending on the type of GLP-1RA. 

Taspoglutide is no longer under investigation, and will not be approved for use.

Consult your doctor about the best treatment option for you.