In type 2 diabetes, the impact of weight should be considered when choosing the most appropriate glucose-lowering therapies. GLP-1 RAs are more effective than DPP-4 inhibitors when weight loss or greater reductions in A1c are treatment priorities. GLP-1 RAs confer weight loss and blood pressure effects that may contribute to long-term cardiovascular efficacy. In addition, GLP-1 RAs also inhibit glucagon secretion, decrease gastric emptying, and reduce appetite through central nervous system pathways. Compared with insulin regimens that may cause weight gain, GLP-1 RAs often result in substantial weight loss, and exogenous administration of GLP-1 has become a widely utilized strategy to lower glucose and weight. Both long-acting and short-acting GLP RAs confer a similar weight loss benefit.
SGLT2 inhibitors have natriuretic and osmotic diuretic effects, whereas GLP-1 RAs have natriuretic and vasodilating effects.
Combination therapy with GLP-1 RAs and DPP-4 inhibitors is not recommended, as both elevate GLP-1 and GIP plasma concentrations with nonsignificant effects on glycemic control.
Learn more about type 2 diabetes guidelines.
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Cite this: Romesh Khardori, Anne L. Peters. Fast Five Quiz: Type 2 Diabetes Incretin-Based Therapy - Medscape - May 16, 2022.