Updated Diabetes Pharmacotherapy Guidelines: GLP1-RAs (Part 1) | Drug News | July 2021

July 2021 | Drug Information and News for Health Care Providers | View PDF

The 2020 Diabetes Canada Pharmacotherapy Update was published with a focus on type 2 diabetes. The main changes in this update are focused on the expanded use of glucagon-like peptide-1 receptor agonists (GLP1-RAs) and sodium glucose cotransporter-2 inhibitor (SGLT2i) medications for cardiorenal protection. Both types of medications have a low risk of causing hypoglycemia, and both can cause weight loss.

Glucagon-like peptide-1 receptor agonists are also called incretin mimetics because they increase levels of the peptide hormone GLP-1 (called an incretin) that increases insulin secretion and decreases glucagon secretion from the pancreas. They impact diabetes management by increasing glucose-dependent insulin release, slowing gastric emptying and inhibiting glucagon release.

Considerations

• Longer-acting agents have greater A1C lowering than short-acting agents
• Contraindicated in those with a personal/family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2

Adverse Events

• Common adverse events include nausea, vomiting, diarrhea
• Rarely, acute gallstone disease


References:

  1. Lipscome L, Butalia S, Dasgupta K, et al. Diabetes Canada Clinical Practice Guidelines Expert Committee. Pharmacologic glycemic management of type 2 diabetes in adults: 2020 update.
    http://guidelines.diabetes.ca/cpg/chapter-13-2020-update. Accessed May 27, 2021.
  2. Diabetes Canada Clinical Practice Guidelines Expert Committee. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes
    2018;42(Suppl 1):S1-S325.
  3. Government of Canada. Drug Product Database. https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/drug-product-database.html. Accessed May 27, 2021.

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