What are the indications and monitoring requirements for GLP1

Indications for GLP-1 Receptor Agonists:

• GLP-1 receptor agonists may be considered for individuals with type 2 diabetes who have obesity and would otherwise require high doses of insulin, or for whom other treatment options are not tolerated or are contraindicated ¹,².
• They can be considered for people with type 2 diabetes who do not have established cardiovascular disease (CVD) but are at high risk of CVD, to reduce the risk of major adverse cardiovascular events. Dulaglutide has the strongest evidence in this regard ¹,².
• GLP-1 receptor agonists (liraglutide, semaglutide, or dulaglutide) are recommended for individuals with type 2 diabetes and established CVD, or those at very high/high risk of CVD, to reduce cardiovascular events. Liraglutide is specifically recommended to reduce the risk of death in this population ¹,².
• GLP-1 receptor agonists are an alternative to initiating insulin and can be considered as a first-line injectable therapy, particularly for those with established CVD, offering potential benefits of weight loss and reduced risk of hypoglycemia ¹,².
• In adults with type 2 diabetes, GLP-1 receptor agonists can be considered as triple therapy if metformin and two other oral drugs are ineffective, not tolerated, or contraindicated, specifically for those with a BMI of 35 kg/m² or higher (with adjustments for minority ethnic groups) and associated psychological or medical problems of obesity, or a lower BMI if insulin therapy would have significant occupational implications or if weight loss would benefit other obesity-related comorbidities ³.
• For children and young people aged 10 years and over with type 2 diabetes, liraglutide or dulaglutide can be offered in addition to metformin if they have an HbA1c level greater than 48 mmol/mol (6.5%), or a fasting plasma glucose level greater than 7 mmol/litre on four or more days a week, or a plasma glucose level 2 hours after meals greater than 9 mmol/litre on four or more days a week ⁴.

Monitoring Requirements:

• Continue GLP-1 receptor agonist therapy only if there is a beneficial metabolic response, defined as a reduction of at least 11 mmol/mol (1.0%) in HbA1c and a weight loss of at least 3% of initial body weight within 6 months ³.
• When starting GLP-1 receptor agonist therapy, other antidiabetic drug treatments may need to be amended ¹,².
• When considering drug treatments, monitoring requirements should be taken into account ³.
• For children and young people with type 2 diabetes, treatment should be reviewed as needed, at least every 3 months, assessing glucose trends using data from glucose monitoring and HbA1c measurements ⁴. If HbA1c monitoring is not feasible, trends can be estimated using glucose profiles, total glycated haemoglobin estimation, or fructosamine estimation ⁴. The frequency of capillary blood glucose monitoring should be adjusted based on treatment and CGM use, ensuring sufficient test strips are available ⁴.