Joshi Nandan, Baloch Kanwal Mir, Rukh Shah, Khan Abdul Moiz, Muskan Fnu, Kumari Verkha, Khan Hasher, Zeeshan Mohd, Azam Ghufran, Khalid Saif, Anwar Insa Binte, Ahmed Iqra Furqan, Nishat Syeed Mahmud, Gandhi Fenil
Department of Internal Medicine, Surat Municipal Institute of Medical Education and Research, Surat, India.
Department of Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
Ann Med Surg (Lond). 2024 Nov 12;86(12):7255-7264. doi: 10.1097/MS9.0000000000002712. eCollection 2024 Dec.
Diabetes mellitus (DM) is a long-term metabolic disorder caused by inadequate production and resistance to insulin. The prevalence of DM is rapidly increasing, with type 2 diabetes (T2D) accounting for more than 90% of cases. Despite new treatments, many patients with T2D do not meet their glycemic targets due to clinical inertia. This review provides an overview of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) in the management of T2D. The review synthesizes data from clinical trials and meta-analyses on the efficacy, safety, and cost-effectiveness of GLP-1 RAs. It also discusses the mechanisms of action, classification, and barriers to adherence and persistence in therapy. GLP-1 RAs improve glycemic control by lowering A1C levels and promoting weight loss. They have cardioprotective effects and may reduce endothelial inflammation, oxidative stress, and blood pressure. Adherence to GLP-1 RAs is better with once-weekly injections, though gastrointestinal side effects and cost can affect persistence. Semaglutide and liraglutide have shown significant weight reduction, with semaglutide being particularly effective. GLP-1 RAs are cost-effective due to reduced healthcare costs associated with fewer hospitalizations and lower mortality rates. Safety concerns include gastrointestinal issues, pancreatitis, and rare cases of diabetic retinopathy and thyroid C-cell tumors. For clinical practice, GLP-1 RAs represent a valuable option not only for glycemic control but also for weight management and cardiovascular protection. Incorporating GLP-1 RAs into treatment plans can improve patient outcomes, and optimizing dosing regimens and addressing barriers such as cost and side effects are crucial to enhancing patient adherence and long-term treatment success.
糖尿病（DM）是一种由胰岛素分泌不足和胰岛素抵抗引起的长期代谢紊乱疾病。糖尿病的患病率正在迅速上升，其中2型糖尿病（T2D）占病例的90%以上。尽管有新的治疗方法，但由于临床惰性，许多T2D患者未能达到血糖目标。本综述概述了胰高血糖素样肽1受体激动剂（GLP-1 RAs）在T2D管理中的应用。该综述综合了来自临床试验和荟萃分析的数据，涉及GLP-1 RAs的疗效、安全性和成本效益。它还讨论了作用机制、分类以及治疗依从性和持续性的障碍。GLP-1 RAs通过降低糖化血红蛋白（A1C）水平和促进体重减轻来改善血糖控制。它们具有心脏保护作用，可能会减少内皮炎症、氧化应激和血压。每周注射一次GLP-1 RAs的依从性更好，不过胃肠道副作用和成本可能会影响持续性。司美格鲁肽和利拉鲁肽已显示出显著的体重减轻，其中司美格鲁肽尤为有效。由于与住院次数减少和死亡率降低相关的医疗保健成本降低，GLP-1 RAs具有成本效益。安全问题包括胃肠道问题、胰腺炎以及罕见的糖尿病视网膜病变和甲状腺C细胞肿瘤病例。对于临床实践，GLP-1 RAs不仅是血糖控制的宝贵选择，也是体重管理和心血管保护的宝贵选择。将GLP-1 RAs纳入治疗计划可以改善患者预后，优化给药方案并解决成本和副作用等障碍对于提高患者依从性和长期治疗成功至关重要。
