NICE guidelines recommend GLP-1 receptor agonists for specific patient populations with type 2 diabetes
Diabetes Care, 46(Supplement_1), S1-S291.
Clinical scenarios warranting consideration of GLP-1 therapy include: Type 2 diabetes management : Per ADA 2024 Standards of Care, GLP-1 RAs may be considered as initial therapy in patients with established atherosclerotic cardiovascular disease (ASCVD), high ASCVD risk, chronic kidney disease (CKD), or heart failure, or as add-on therapy when glycemic targets aren't met Established cardiovascular disease : Several GLP-1 receptor agonists have demonstrated cardiovascular risk reduction in patients with type 2 diabetes and established ASCVD Chronic kidney disease : While SGLT2 inhibitors are generally prioritized for CKD with type 2 diabetes when eGFR allows, GLP-1 RAs may provide complementary benefits Obesity with complications : When lifestyle interventions produce insufficient weight loss in patients with obesity-related comorbidities Important safety considerations include: Contraindications : Personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2
Nonetheless, these clinical trials were underpowered to detect rare events such as suicidal ideation and self-injurious behavior, and they systematically excluded patients with psychiatric comorbidities commonly seen in clinical settings
Patients with pre-existing retinopathy should have appropriate monitoring
The Primary Care Companion For CNS Disorders , 27 (3)
