Naplex Prep: Diabetes I - GLP-1 & GLP1/GIP Agonists

What is a GLP-1 agonist?

A longer acting analog of GLP-1 (longer than the endogenous GLP-1); activates the GLP-1 receptor

How can GLP-1 affect the body?

Increases amount of insulin produced BEFORE BG elevates (increase beta cell function), lowers glucagon secretion after meals (decrease glucose production), increases CNS satiety (decrease food intake), slows gastric emptying (decrease glucose absorption), and increases glucose uptake into skeletal and adipose tissue

When is GLP-1 secreted?

Upon ingestion of food

What does GLP-1 stand for?

Glucagon-like peptide-1

How is GLP-1 produced?

By L-cells of the ileum in minutes after oral intake of glucose (does not come from pancreas)

Are GLP-1 levels diminished in DM1 or DM2?

DM2

What enzyme can breakdown GLP-1?

DPP-IV

Brand: Byetta

exenatide

Brand: Bydureon

exenatide ER

Brand: Victoza

liraglutide

Brand: Trulicity

dulaglutide

Brand: Adlyxin

lixisenatide

Which are the only GLP-1 agonist that are not a once weekly injection?

Byetta (exenatide) BID

liraglutide (victoza, saxenda) - daily

semaglutide (ONLY rybelsus (oral)) - daily

Which GLP-1 agonists need reconstitution?

Bydureon

glp1 ADRs

gip/glp1 adr specific

Hypoglycemia (low risk unless paired with secretagogue or insulin),

N/V (mostly with exenatide daily; titrate slowly), pancreatitis (rare), weight loss,

tirzepatide: increased heart rate

when to avoid GLP-1

H/O of thyroid c cell carcinomas

glp1 and glp1/gip - Renal impairment adjustment?

NOT rec'd:

-exenatide (byetta) if CrCl < 30 mL/min

-exenatide er (bydureon bcise) if crcl <45

no other adjustments needed

What are some tips to combat GI side effects in a pt starting this agent? glp1/glp1-gip

Titrate slowly, tell pt to eat slower, and to eat less

Which pts are most likely to benefit from GLP-1 agonist?

Early DM2 pts (still making insulin), pts who could benefit from monotherapy but can't take metformin or sulfonylurea, pts with hazardous occupations where hypoglycemia is dangerous, or overweight pts

GLP1/ GLP1/GIP

Effect on A1C?

decrease 0.5-1.5% : decreases post-prand BG with minimal hypoglycema risk (unless used w insulin)

GLP1/ GLP1/GIP

Glucose dependent or independent?

Dependent (stimulates insulin secretion)

Which ones are short acting? (admin QD or BID)

Byetta (BID), Victoza (QD), Adlyxin (QD)

GLP1/ GLP1/GIP

BBW

Thyroid C-cell tumors (neck swelling/growth); in animal studies

all except byetta

When to avoid exenatide?

CrCl < 30 mL/min (use caution with all agents and renal impairment)

GLP1/ GLP1/GIP

T/F even initial low doses of GLP1/ GLP1/GIP may show glucose lowering effects

F, lower may not. start low and titrate up to reduce gi ades

GLP1/ GLP1/GIP - drug interactions

KL is a 28 yr old female, iwith T2DM, HTN, Obesity, who has just started a glp1/gip agonist. what counseling should she receive on possible drug interactions based on her current medications below?

Mounjaro

Lisinopril

Loestrin-Fe

Loestrin - Fe

ALL pts using HORMONAL contraception are advised to switch to non-oral or barrier method of contraception for 4 WEEKS after INITIATION and 4 WEEKS after each DOSE ESCALATION

for both mounjaro and zepbound

GLP1/ GLP1/GIP - drug interactions

LJ is a 54 yr old male with T2DM, Afib, HTN, Obesity who has just started exenatide. what counseling should he receive on possible drug interactions based on his current medications below.

Exenatide

Warfarin

Lisinopril

Metofrmin

warfarin -

exenatide can increase the INR of pts on warfarin