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Comparative studies of insulin vs glucagon‐like peptide‐1 receptor agonists in patients initiating injectable therapy

Although oral glucose-lowering agents are recommended as initial pharmacological therapy in patients with type 2 diabetes, the steady decline in β-cell function results in progressive hyperglycaemia, which requires a stepwise escalation of treatment. Current treatment algorithms promote a patient-centred approach that takes into consideration the pharmacological properties of drugs, including glucoselowering action, effects on body weight, tolerability and long-term safety. When oral glucose-lowering medications are no longer able to control hyperglycaemia, injectable therapy has to be considered. Two options exist: initiation of a glucagon-like peptide-1 receptor agonist (GLP-1RA) or of insulin. GLP-1RAs, in addition to lowering glycated haemoglobin (HbA1c) levels, also reduce body weight by decreasing appetite and caloric intake. As a result of their glucose-dependent action on endogenous insulin and glucagon secretion, the risk of hypoglycaemia is minimal. Currently, six GLP-1RAs are available and have distinct modes of action. Notably, short-acting GLP-1RAs (exenatide twice daily and lixisenatide once daily) and long-acting GLP-1RAs (liraglutide once daily, albiglutide once weekly, exenatide once weekly and dulaglutide once weekly) differ in relation to dosing, efficacy in reducing fasting plasma glucose, postprandial glucose and HbA1c, gastric emptying rate and tolerability.