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Non-insulin injectables: What GPs need to know

Incretins are hormones released by the intestine that regulate many metabolic pathways, including glucose control. Incretin hormones were discovered over one hundred years ago.

GLP-1 receptor agonists augment the incretin effect to improve glucose control in patients with type 2 diabetes.

The average HbA1c drop due to these medications is over 1%, according to diabetes researcher Prof Merlin Thomas. This, combined with significant weight loss and a low risk of symptomatic hypoglycaemia, makes them very attractive as an additional treatment in patients with type 2 diabetes whose blood glucose levels are not optimally controlled.

Prof Thomas (who will be revealing more in an upcoming lecture at the upcoming 2019 General Practice Education Day in Sydney next month), notes that GLP-1 agonists are now recommended and the first line injectable therapy, before basal or mixed insulin.

However, the big challenge with GLP-1RAs is adherence, due to their gastrointestinal effects especially at the beginning and when increasing the doses. Prof Thomas will be discussing the simple ways to minimise and manage nausea with these agents to ensure patients can get the most of this exciting new therapy.

The other big issue is that GLP-1RAs must be administered by injection. Everyone prefers an oral agent over an injectable. But GLP-1RAs are not the same as insulin. In fact, the fixed-dose pens and hidden needles make many a lot easier to use. Prof Thomas will explain in his lecture how to discuss the administration of GLP-1 agonists in such a way that patients are still happy to use and keep using them.

In summary, The GLP-1 agonists are a novel class of non-insulin injectables that GPs should become familiar with. They have a generally favourable side-effect profile. If you can get through the early phase of GI side effects and injections, then the long-term benefits may be significant.

Prof. Merlin Thomas will share more of the advantages and disadvantages of, and the indications for, this novel class of glucose-lowering treatment in the management of diabetes at the 2019 General Practice Education Day in Sydney. This will take place at the ICC Sydney on 24 August.