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Now, patients have access to once-weekly injections and an oral formulation, semaglutide (Rybelsus), for those who prefer to avoid needles. GLP-1s and the ADA Guidelines: A New First-Line Therapy The American Diabetes Associations 2024 Standards of Care are clear: GLP-1 RAs are often first-line agents for patients with type 2 diabetes who also have atherosclerotic cardiovascular disease, chronic kidney disease, or obesity. For patients with a body mass index (BMI) of 30 kg/m or higher or elevated cardiovascular risk, semaglutide or tirzepatide may be considered before initiating metformin, especially when weight loss or cardioprotection is the top priority. More Than Just A1C Control While GLP-1s are effective for lowering blood glucose, the added clinical benefits are just as important: Weight loss : Many patients experience a reduction of 10 percent or more in total body weight. Cardiovascular protection : Liraglutide, dulaglutide, and semaglutide have demonstrated reductions in major adverse cardiovascular events. Renal protection : These agents may slow the progression of chronic kidney disease. GLP-1s are also being studied for a wide range of potential uses, including nonalcoholic steatohepatitis (NASH), obstructive sleep apnea, heart failure with preserved ejection fraction, and even Alzheimers disease. What APRNs Should Know Before Starting GI side effects, particularly nausea and vomiting, are the most common patient complaints
M., Holst J
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While the ADA recommends considering a GLP-1 receptor agonist or the addition of mealtime insulin, 3 the AACE/ACE algorithm additionally recommends SGLT-2 inhibitors and DPP-4 inhibitors as potential therapies that can be added to basal insulin, if they are not already incorporated into the medication regimen
