Role of GLP-1s in the management of persons with type 2 diabetes

The number of people in the UK with diagnosed diabetes has risen from 1.4 million in 1996 to 3.5 million today. Once the number of people with undiagnosed diabetes is factored in, this equates to over 4 million,2 with men accounting for 56% to women’s 44%.
In the UK, type 2 diabetes accounts for approximately 90% of all diabetes cases.

An estimated £14billion is spent on treating diabetes and its complications annually, the latter being the much greater component.

Individualised treatment

In the management of adults with type 2 diabetes, UK Guideline 2015 recommends the adoption of an individualised approach that is tailored to the needs and circumstances of the patient, taking into account their personal preferences, comorbidities, risks from polypharmacy and their ability to benefit from long-term interventions because of reduced life expectancy.
Such an approach is of particular importance in the context of multimorbidity, and the person’s needs and circumstances must be reassessed at each review.

For adults with type 2 diabetes being managed by lifestyle and diet, or by lifestyle and diet combined with a single drug ,Doctors should support the person to aim for an HbA1c level of 53 mmol/mol.
If HbA1c levels are not adequately controlled by a single drug and rise to 58mmol/mol or higher, the advice is to reinforce advice about diet, lifestyle and treatment adherence, to support the person to aim for the 53mmol/mol target and to intensify drug treatment.

Role for GLP-1s

Initial drug treatment for adults with type 2 diabetes is standard-release metformin.
If, however, triple therapy with metformin and two other oral drugs is not effective in optimising the lowering of HbA1c, or not tolerated or not indicated,
and for whom insulin therapy would have significant occupational implications,
and for whom weight loss would benefit other significant obesity-related comorbidities:

combination therapy metformin, a sulfonylurea and a glucagon-like peptide (GLP-1) mimetic is to be considered for those adults who have a BMI of 35kg.m2 or higher and specific medical problems associated with obesity, or who have a BMI lower than 35kg.m2.

NB- What are the GLP1 drugs? – watch this space!