The drug atlas
Endocrine & Metabolic/GLP-1 receptor agonist
GLP-1 receptor agonists
also: semaglutide · liraglutide · dulaglutide · Ozempic · incretin mimetic
Overview
Injectable incretin mimetics for T2DM that also drive weight loss — increasingly used for obesity. Glucose-dependent action → minimal hypoglycaemia.
Mechanism
Agonise the GLP-1 receptor → glucose-dependent ↑insulin + ↓glucagon, slowed gastric emptying, and central satiety → lower glucose and weight.
Indications
- Type 2 diabetes (esp. with obesity)
- Obesity (semaglutide/liraglutide)
The agents
Semaglutideweekly (also oral)
SC weekly
Marked weight loss; also licensed for obesity.
Liraglutidedaily
SC daily
Dulaglutideweekly
SC weekly
Adverse effects
Nausea / vomiting (dose-related)classic
Titrate slowly.
Pancreatitisserious
Gallstonescommon
Cautions & contraindications
Personal/family history of medullary thyroid carcinoma / MEN2all
History of pancreatitisall
Do not combine with a DPP-4 inhibitorall
Same incretin pathway — no added benefit.
Interactions
- Additive hypoglycaemia with sulfonylureas/insulin (reduce their dose)
- Delayed gastric emptying affects other drug absorption
Monitoring & kinetics
Weight, HbA1c, renal function
Subcutaneous (semaglutide also oral). Glucose-dependent → low hypoglycaemia risk.
Source: NICE NG28 — T2DM · BNF — GLP-1 agonists