The mode and mechanism of action of once-weekly glucagon-like peptide-1 receptor agonists in type 2 diabetes

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are an efficacious and convenient option for the treatment of type 2 diabetes (T2D). This narrative review assesses the mode and mechanism of action of the GLP-1RA class in general and highlights similarities and differences within the class. Published clinical trials and manuscripts of basic scientific research were collated and critically reviewed for information relating to the mode and mechanism of action of GLP-1RAs. The mode and mechanism of action is consistent across the GLP-1RA class, despite differences in sequence homology, formulation, conjugation and device administration. Within the class there are some differences in efficacy with regard to glycemic control. Crucially, cardiovascular benefit with GLP-1RAs cannot at this time be considered as a class effect. Once-weekly GLP-1RAs are a good therapeutic option for patients with T2D, either as monotherapy or as part of a combination therapy. Differences between these agents in terms of efficacy and safety outcomes, as well as convenience of a particular device and regimen, should be considered as part of individualization of therapy for patients unable to achieve glycemic control with metformin alone.