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endocrine:glp1:start [2026/02/13 00:10] – created andrew2393cnsendocrine:glp1:start [2026/02/13 00:14] (current) – [Clinical Pearls] andrew2393cns
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 They are foundational agents in: They are foundational agents in:
  
-• Type 2 Diabetes+• Type 2 Diabetes Mellitus
 • Obesity • Obesity
 • Atherosclerotic Cardiovascular Disease (ASCVD) • Atherosclerotic Cardiovascular Disease (ASCVD)
  
-Unlike [[endocrine:sglt2:start|SGLT2 Inhibitors]], GLP-1 agents primarily reduce atherosclerotic events rather than heart failure hospitalization.+Unlike [[endocrine:sglt2:start|SGLT2 Inhibitors]], GLP-1 receptor agonists primarily reduce atherosclerotic cardiovascular events rather than heart failure hospitalization.
  
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 ===== Mechanism of Action ===== ===== Mechanism of Action =====
  
-GLP-1 (Glucagon-Like Peptide-1) is an incretin hormone released from the gut after meals.+GLP-1 (Glucagon-Like Peptide-1) is an incretin hormone released after meals.
  
 GLP-1 receptor agonists: GLP-1 receptor agonists:
  
-• Increase glucose-dependent insulin secretion +• Increase glucose-dependent insulin secretion   
-• Decrease glucagon secretion +• Decrease glucagon secretion   
-• Slow gastric emptying +• Slow gastric emptying   
-• Increase satiety +• Increase satiety   
-• Promote weight loss+• Promote weight loss  
  
-Net Effects: +Because insulin release is glucose-dependent, hypoglycemia risk is low unless combined with insulin or sulfonylureas.
- +
-• ↓ Blood glucose +
-• ↓ Postprandial glucose +
-• ↓ Body weight +
-• ↓ Major adverse cardiovascular events (MACE) +
- +
-They do NOT cause insulin release in the absence of glucose → low hypoglycemia risk.+
  
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-===== Available Agents =====+===== FDA-Approved GLP-1 Receptor Agonists (Chronologic Order) =====
  
-• [[endocrine:glp1:semaglutide|Semaglutide]] +  * • [[endocrine:glp1:exenatide|Exenatide]] (2005)   
-• [[endocrine:glp1:liraglutide|Liraglutide]] +  * • [[endocrine:glp1:liraglutide|Liraglutide]] (2010)   
-• [[endocrine:glp1:dulaglutide|Dulaglutide]] +  * • [[endocrine:glp1:dulaglutide|Dulaglutide]] (2014)   
-• [[endocrine:glp1:exenatide|Exenatide]]+  * • [[endocrine:glp1:semaglutide|Semaglutide]] (2017 injectable; 2019 oral)  
  
-(Additional agents may be added as PharmAtlas expands.)+Each agent differs in half-life, dosing frequency, and cardiovascular outcome data.
  
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-===== Indications =====+===== Cardiovascular Effects =====
  
-==== Type 2 Diabetes Mellitus ====+GLP-1 receptor agonists reduce:
  
-• Glycemic control +  * • Myocardial infarction   
-• Weight reduction +  * • Stroke   
-• Reduction of ASCVD risk+  * • Cardiovascular death  
  
--------------------------------------------------------------------- +Strongest ASCVD data:
- +
-==== Obesity ★ ==== +
- +
-• Significant weight loss +
-• Reduces visceral adiposity +
-• Improves metabolic profile +
- +
--------------------------------------------------------------------- +
- +
-==== Atherosclerotic Cardiovascular Disease (ASCVD) ★ ==== +
- +
-GLP-1 receptor agonists reduce:+
  
-• Myocardial infarction +  * • [[endocrine:glp1:liraglutide|Liraglutide]]   
-• Stroke +  * • [[endocrine:glp1:semaglutide|Semaglutide]]   
-• Cardiovascular death+  * • [[endocrine:glp1:dulaglutide|Dulaglutide]]  
  
-Particularly beneficial in patients with established ASCVD.+They are particularly beneficial in patients with established ASCVD.
  
 → [[cardio:intro:start|Cardiovascular Modules]] → [[cardio:intro:start|Cardiovascular Modules]]
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 • They are NOT core therapies for heart failure. • They are NOT core therapies for heart failure.
-• They do NOT provide strong HF hospitalization reduction.+• They do NOT significantly reduce HF hospitalization compared to SGLT2 inhibitors.
  
-For heart failure benefit, see:+For heart failure benefit:
  
 → [[endocrine:sglt2:start|SGLT2 Inhibitors]] → [[endocrine:sglt2:start|SGLT2 Inhibitors]]
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 Common: Common:
  
-• Nausea +  * • Nausea   
-• Vomiting +  * • Vomiting   
-• Diarrhea +  * • Diarrhea   
-• Early satiety+  * • Early satiety  
  
 Serious (rare): Serious (rare):
  
-• Pancreatitis +  * • Pancreatitis   
-• Gallbladder disease +  * • Gallbladder disease   
-• Medullary thyroid carcinoma risk (theoretical; avoid in MEN2)+  * • Medullary thyroid carcinoma risk (avoid in MEN2)  
  
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 ===== Contraindications ===== ===== Contraindications =====
  
-• Personal or family history of medullary thyroid carcinoma +• Personal or family history of medullary thyroid carcinoma   
-• MEN2 syndrome +• MEN2 syndrome   
-• Severe GI disease +• Severe gastrointestinal disease  
- +
-Use caution in: +
- +
-• Pancreatitis history+
  
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 GLP-1 receptor agonists: GLP-1 receptor agonists:
  
-• Strong weight loss +  * • Strong weight loss   
-• Strong ASCVD benefit +  * • Strong ASCVD reduction   
-• Minimal HF benefit+  * • Minimal HF benefit  
  
 [[endocrine:sglt2:start|SGLT2 Inhibitors]]: [[endocrine:sglt2:start|SGLT2 Inhibitors]]:
  
-• Strong HF benefit +  * • Strong HF benefit   
-• Strong CKD protection +  * • Strong CKD protection   
-• Mild weight loss+  * • Mild weight loss  
  
-These classes are often complementary.+These classes are often complementary in cardiometabolic disease.
  
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 ===== Clinical Pearls ===== ===== Clinical Pearls =====
  
-✔ Glucose-dependent insulin release   +  * ✔ Glucose-dependent insulin release   
-✔ Promote weight loss   +  * ✔ Promote weight loss   
-✔ Reduce atherosclerotic events   +  * ✔ Reduce ASCVD events   
-✔ Low hypoglycemia risk (unless combined with insulin)   +  * ✔ Low hypoglycemia risk   
-✔ Not primary HF therapy   +  * ✔ Not primary HF therapy   
-✔ Complementary to SGLT2 inhibitors  +  * ✔ Complementary to SGLT2 inhibitors  
  
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 Related: Related:
  
-→ [[endocrine:sglt2:start|SGLT2 Inhibitors]] +→ [[endocrine:sglt2:start|SGLT2 Inhibitors]]   
-→ [[cardio:heart_failure:start|Heart Failure Module]] +→ [[cardio:heart_failure:start|Heart Failure Module]]   
-→ [[cardio:intro:start|Cardiovascular Modules]]+→ [[cardio:intro:start|Cardiovascular Modules]]  
 → [[endocrine:start|Endocrine Pharmacology]] → [[endocrine:start|Endocrine Pharmacology]]
endocrine/glp1/start.1770941431.txt.gz · Last modified: by andrew2393cns