If metformin is not effective in controlling blood sugar, GLP-1 receptor agonists can be used to protect cardiovascular

A friend who suffers from diabetes left a message to Huazi, saying that he still couldn't control his blood sugar after taking metformin and acarbose. Someone suggested that he use a drug called "peptide" for treatment, saying that it is good for the heart. What type of drug is this?

Huazi said that the hypoglycemic drugs with the word "peptide" in their names should refer to GLP-1 receptor agonists. Commonly used drugs include liraglutide, dulaglutide, semaglutide, exenatide microspheres, loxenatide, etc. These drugs can not only lower blood sugar, but also have cardiovascular protective effects.

1. What is a GLP-1 receptor agonist?

The human intestine can secrete a multifunctional peptide hormone that can activate the glucagon-like peptide-1 (GLP-1) receptor , promote the secretion of insulin in a glucose-dependent manner, delay gastric emptying, reduce food intake, and reduce weight.

However, the peptide hormones naturally secreted by the human body will be quickly decomposed by dipeptidyl peptidase 4 (DPP-4) after entering the blood, and lose their effect. Therefore, people have developed GLP-1 receptor agonists that are similar in structure to the natural peptide hormones of the human body, which can also activate the GLP-1 receptor to play a role in lowering blood sugar.

GLP-1 receptor agonists are glucose-dependent, with a low risk of hypoglycemia. They also have a protective effect on nerve cells and myocardial cells while lowering blood sugar .

2. Commonly used GLP-1 receptor agonists

There are many GLP-1 receptor agonists on the market, among which liraglutide, dulaglutide and semaglutide are the most commonly used . The oral formulation of semaglutide is being applied for in China, and it will take some time before it is launched on the market. Currently, all three have injection formulations. Liraglutide needs to be injected once a day; dulaglutide and semaglutide need to be injected once a week .

Liraglutide and semaglutide are approved for weight loss treatment for obese people in the United States, while dulaglutide is only used for the treatment of type 2 diabetes. However, in China, all three drugs can only be used to treat type 2 diabetes, not for weight loss .

Semaglutide was developed based on liraglutide, so semaglutide can be regarded as a "weekly preparation" of liraglutide . Dosing once a week is more convenient and can improve patients' medication compliance. Therefore, the main types of GLP-1 receptor agonists are dulaglutide and semaglutide.

3. The difference between dulaglutide and semaglutide

The half-life of dulaglutide is 4.7 days, and the half-life of semaglutide is 7 days. The longer the half-life, the smaller the change in blood drug concentration during treatment, so the drug concentration of semaglutide is more stable .

The commonly used dose of dulaglutide is 1.5 mg, and the commonly used dose of semaglutide is 0.5 mg. Both can reduce glycated hemoglobin (HbA1c) by 1.5% compared with baseline. However, when semaglutide is used at 1.0 mg, HbA1c can be reduced by 1.8%.

In terms of controlling blood sugar, reducing weight, and lowering blood pressure, semaglutide is more effective than dulaglutide .

In terms of cardiovascular protection, dulaglutide has a broad cardiovascular protective effect on patients with type 2 diabetes, while semaglutide has a protective effect on patients with type 2 diabetes who have coronary atherosclerotic cardiovascular disease.

Therefore, compared with the two, semaglutide is a more suitable choice for type 2 diabetes patients who want to lose weight , while dulaglutide is more suitable for type 2 diabetes patients who need cardiovascular protection .

In summary, if blood sugar is still not well controlled by using metformin and other hypoglycemic drugs on the basis of controlling diet and increasing exercise, GLP-1 receptor agonists can be used for treatment. While lowering blood sugar, they also have a good protective effect on the cardiovascular system. Drugs must be used under the guidance of a doctor. If you have any questions about medication, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.