Glucagon-Like Peptide-1 Receptor Agonists in Primary Care: Beyond Glycemic Control

Abstract

Type 2 diabetes (T2D) is no longer considered solely a glucosecentric condition, but rather a chronic cardiometabolic disease that is linked to premature cardiovascular and renal complications and early death. Whereas previously, the level of glycemic control drove management decisions regarding treatment intensification, healthcare providers now have newer classes of agents that not only effectively lower glucose levels but also reduce the long-term risk of cardiovascular and renal complications. Glucagon-like peptide- 1 receptor agonists (GLP-1RAs) address several of the progressive multiorgan dysfunctions associated with T2D and a number of GLP-1RAs have been shown to reduce the risk of major adverse cardiovascular events in people with established cardiovascular disease or in those at high cardiovascular risk; GLP-1RAs (or a cardioprotective sodium-glucose cotransporter-2 inhibitor) should be considered in these high-risk patients regardless of their glycated hemoglobin goal attainment status. GLP-1RAs also facilitate substantial weight loss and there is some evidence that they may help to restore β-cell function and slow the decline of kidney function, although further studies are needed to confirm this.