Guide to using GLP-1RAs for T2D in primary care – Your questions answered

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Description

The questions answered in this podcast are listed below. They were compiled by GPs and health professionals around Australia.

  1. How to administer GLP1Ras? Dosing and titration?
  2. What are the differences with the current weekly GLP1RAS?
  3. How should the injections be stored?
  4. When to start? Who would benefit the most? Who should it NOT be used in?
  5. How do you manage the GI side effects?
  6. Duration of treatment?
  7. Are there any drug interactions?
  8. Choice of therapy after metformin
  9. Under PBS what other OHA can they be used with?
  10. Can they be used for people with T2DM with an HbA1c <7%?
  11. What are the TGA approved use of GLP1RAs?
  12. GLP1RAs – Are there any CVD benefits (IHD and CCF)? Renal benefits?
  13. Clarify why DPP4i and GLP1RA shouldn’t be used together
  14. What would make you stop a GLP1RA? What happens when you stop GLP1RAs?
  15. Do people develop a tolerance to GLP1RAs?
  16. Are they safe for long term use?
  17. Why is there an increase in retinopathy and cholelithiasis?
  18. What tests should be done before starting a GLP1RA? (tests of pancreas, thyroid us, eye screen, gall bladder?
  19. Should patients have their lipase monitored?
  20. If someone has a history of pancreatitis can they use GLP1RAs?
  21. If there is a history of thyroid cancer, can a GLP1RA be used?
  22. Compliance – is there any data on cessation or how long people stay on the medication in the real world?
  23. Is the compounded semaglutide safe?
  24. Is fatigue a common side effect? If you have GI side effects that persist is it worth changing brand?
  25. Off label prescribing – what protections do we have?
  26. How long to stop GLP1RAs before conception? If conceives whilst on these medications what does it mean for the foetus?
  27. Does it burn out the pancreas?
  28. How do they work? How effective are they?
  29. How many people do not respond and why?
  30. A stack of questions on availability?

Guest: Facilitator A/Prof Ralph Audehm, General Practitioner
Panelists Dr Richard MacIsaac, Endocrinologist & Prof Richard O’Brien, Endocrinologist

Host: Dr David Lim, GP and Medical Educator

Total time: 55 mins

Last Updated: 5 Oct, 2023

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A/Prof Ralph Audehm

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A/Prof Ralph Audehm

General Practitioner

Prof Richard O'Brien

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Prof Richard O'Brien

Endocrinologist; Clinical Dean of Medicine, University of Melbourne, Austin Clinical School; Director of Graduate Programs, Melbourne Medical School; Senior Endocrinologist and Director, Lipid Service, Austin Health

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Endocrinologist, Director, St Vincent’s Hospital Melbourne; Professor, University of Melbourne

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