Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Mar 15, 2024; 15(3): 326-330
Published online Mar 15, 2024. doi: 10.4239/wjd.v15.i3.326
Glucagon-like-peptide-1 receptor agonists and the management of type 2 diabetes-backwards and forwards
Michael Horowitz, Lu Cai, Md Shahidul Islam
Michael Horowitz, Department of Medicine, University of Adelaide, Adelaide 5005, Australia
Lu Cai, Pediatric Research Institute, University of Louisville, Louisville, KY 40202, United States
Md Shahidul Islam, Department of Biochemistry, School of Life Sciences, University of KwaZulu-Natal, Durban 4000, KwaZulu-Natal, South Africa
Author contributions: Horowitz M conceptualised and wrote the first draft of the editorial; Islam MS and Cai L made revisions and editorial corrections before submission; All authors have read and approved the final manuscript.
Conflict-of-interest statement: Horowitz M, Cai L and Islam MS have no conflict of interest within this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Michael Horowitz, MBBS, PhD, DSc, FRACP, AO, Director, Endocrine and Metabolic Unit, Royal Adelaide Hospital and Professor, Department of Medicine, University of Adelaide, Level 5, AHMS Corner North Tce and George St, Adelaide 5005, Australia. michael.horowitz@adelaide.edu.au
Received: January 28, 2024
Peer-review started: January 28, 2024
First decision: February 8, 2024
Revised: February 14, 2024
Accepted: February 23, 2024
Article in press: February 23, 2024
Published online: March 15, 2024
Processing time: 47 Days and 3.1 Hours
Abstract

This editorial is stimulated by the article by Alqifari et al published in the World Journal of Diabetes (2024). Alqifari et al focus on practical advice for the clinical use of glucagon-like-peptide-1 (GLP-1) receptor agonists (GLP-1RAs) in the management of type 2 diabetes and this editorial provides complementary information. We initially give a brief historical perspective of the development of GLP-1RAs stimulated by recognition of the ‘incretin effect’, the substantially greater insulin increase to enteral when compared to euglycaemic intravenous glucose, and the identification of the incretin hormones, GIP and GLP-1. In addition to stimulating insulin, GLP-1 reduces postprandial glucose levels by slowing gastric emptying. GLP-1RAs were developed because native GLP-1 has a very short plasma half-life. The majority of current GLP-1RAs are administered by subcutaneous injection once a week. They are potent in glucose lowering without leading to hypoglycaemia, stimulate weight loss in obese individuals and lead to cardiovascular and renal protection. The landscape in relation to GLP-1RAs is broadening rapidly, with different formulations and their combination with other peptides to facilitate both glucose lowering and weight loss. There is a need for more information relating to the effects of GLP-1RAs to induce gastrointestinal symptoms and slow gastric emptying which is likely to allow their use to become more effective and personalised.

Keywords: Glucagon-like-peptide-1; Glucose-dependent insulinotropic peptide; Gastric emptying; Type 2 diabetes

Core Tip: In people who are prescribed a glucagon-like-peptide-1 receptor agonist (GLP-1RA) for management of type 2 diabetes or obesity you should always ask about gastrointestinal symptoms both before and after initiating therapy. Gastrointestinal adverse effects of GLP-1RAs are common, but may not be volunteered.