Written on February 22, 2023 by Sendra Yang, PharmD, MBA. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
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Diabetes is a chronic disease where your body does not make enough or cannot use insulin, leading to high sugar levels in your blood . Insulin is a hormone your pancreas produces to help uptake sugar into your cells for energy. The two most common types of diabetes are type 1 and 2.
The National Diabetes Statistics Report from the Centers for Disease Control and Prevention estimates that approximately 37 million people in the United States have diabetes . Of these 37 million people, up to 95% have type 2 diabetes .
Type 2 diabetes is known as adult-onset diabetes because it is more common in adults, but it can also occur in children and young adults . In type 2 diabetes, your body is not able to use insulin well and cannot sufficiently take sugar into your cells to use for energy.
Signs and symptoms of type 2 diabetes can develop over time. You may be living with type 2 diabetes and not know it. Signs and symptoms include :
Currently, there is no cure for type 2 diabetes [4,5]. Strategies for managing type 2 diabetes include losing weight, eating a well-balanced diet, and exercising . However, sometimes changing your diet and exercising may not be enough to manage the condition. You may also need diabetes medications to help bring your sugars within a healthy range. Though there are many types of medications available, one drug class that can help you manage your type 2 diabetes is GLP-1 medications .
GLP-1 medications are also known as glucagon-like peptide-1 (GLP-1) agonists, GLP-1 receptor agonists, incretin memetics, or GLP-1 analogs [5,6].
GLP-1 receptor agonists (GLP-1 RAs) are a category of medications used to treat type 2 diabetes in adults [5,6]. The first GLP-1 medication, exenatide, was approved by the US Food and Drug Administration (FDA) in April 2005 for the treatment of type 2 diabetes . Though GLP-1 RAs are not first-line therapies, this class of medications is suggested for adult type 2 diabetics with cardiovascular risks, is preferred to insulin when possible, and is recommended in combination therapy with insulin if insulin must be used .
GLP-1 medications act like naturally producing GLP-1 hormones in the body [6,8]. GLP-1 helps to regulate glucose or sugar levels in the body. Carbohydrates and fats in the diet stimulate the release of GLP-1 hormones. GLP-1 binds and activates the GLP-1 receptors to enhance insulin secretion and synthesis from the pancreas by promoting beta cells, suppressing glucagon secretion, slowing gastric emptying, and reducing food intake by decreasing appetite. Thus, GLP-1 RAs help improve blood sugar control and can reduce weight in type 2 diabetics.
Most GLP-1 medications or GLP-1 RAs are injectables [5-8]. The only approved oral GLP-1 RA is semaglutide, a once-a-day pill.
The available GLP-1 RA injectables are short or long-acting, and include [5,8-14]:
Non-medication management strategies for type 2 diabetes involve lifestyle modifications like diet and exercise. Exercise or physical activity is essential as part of the therapy for managing type 2 diabetes. Moderate-intensity activities, such as brisk walking, for about 150 minutes per week have shown beneficial effects on type 2 diabetes .
Combining GLP-1 medications with exercise has a synergistic effect to help lower glucose levels in the body. GLP-1 medications are approved for use with diet and exercise to treat type 2 diabetes [9-14]. Exercise in combination with GLP-1 medications appears to enhance the GLP-1 function leading to better sugar control in type 2 diabetics, though the exact way it works is not clear . A 16-week study found that liraglutide combined with exercise achieved close to normal hemoglobin A1c levels with a reduction in weight when compared to placebo and exercise .
If you have type 2 diabetes, you have an elevated risk of developing cardiovascular diseases, such as myocardial infarction or heart attack, heart failure, peripheral artery disease, stroke, and cardiovascular death [18-20]. Cardiovascular diseases are the most prevalent cause of morbidity and mortality among patients with type 2 diabetes [19, 20]. Globally, approximately 32% of people with type 2 diabetes are affected by cardiovascular diseases .
According to the American Diabetes Association recommendations, GLP-1 medications with demonstrated beneficial cardiovascular effects are dulaglutide, semaglutide, and liraglutide . These three GLP-1 medications are also currently FDA-approved based on clinical studies to reduce cardiovascular risks in adults with type 2 diabetes [9-14]. Multiple large clinical trials report significant reductions in cardiovascular events in adults with type 2 diabetes [5,22]. A meta-analysis study of 8 clinical trials, including over 60,000 patients with a primary outcome of major adverse cardiovascular events, found an overall GLP-1 medication reduction rate of 14% . Additional results of the meta-analysis showed GLP-1 medications reduced all-cause mortality by 12% and hospital admission for heart failure by 11% in type 2 adult patients. The meta-analysis reported several limitations since it included multiple studies.
GLP-1 RAs have a preferable safety profile in terms of improved weight loss and low risk for hypoglycemia . However, GLP-1 medications also have different adverse reactions and contraindications. Common adverse reactions of GLP-1 medications are nausea, vomiting, and diarrhea . Other adverse reactions include dizziness, mild tachycardia, infections, headaches, and dyspepsia. In longer-acting GLP-1 medications, injection-site pruritus and erythema are also common. Safety concerns include pancreatitis, thyroid cancer, and severe gastrointestinal issues, and GLP-1 medications should be avoided in people with a history of these conditions .
If you have type 2 diabetes and want to learn more about GLP-1 medications, consider speaking with a healthcare provider. Everlywell provides access to a virtual telehealth option for weight management online where you can schedule a meeting with a certified, licensed provider to discuss your health and GLP-1 medication. Everlywell also works with a network of labs to get you access to various tests. Learn more about Everlywell and what is available for you.