Use of continuous glucose monitoring when initiating glucagon‐like peptide‐1 receptor agonist therapy in insulin‐treated diabetes

• Published in: Diabetes, obesity & metabolism obesity & metabolism, 2024-12, Vol.26 (S7), p.17-26
• Main Authors: Hirsch, Irl B., Parkin, Christopher G., Cavaiola, Tricia Santos, Bergenstal, Richard M.
• Format: Article
• Language: English
• Subjects: Agonists; Blood Glucose - analysis; Blood Glucose - drug effects; Blood Glucose - metabolism; Blood Glucose Self-Monitoring - methods; Cardiovascular system; CGM; Congestive heart failure; Continuous Glucose Monitoring; Diabetes mellitus (insulin dependent); Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; GLP‐1RA; Glucagon; Glucagon-Like Peptide-1 Receptor - agonists; glucagon‐like peptide‐1 receptor agonist; Glucose monitoring; Heart diseases; Humans; hypoglycaemia; Hypoglycemia; Hypoglycemia - chemically induced; Hypoglycemia - prevention & control; Hypoglycemic Agents - therapeutic use; Insulin; Insulin - therapeutic use; Kidney diseases; Myocardial infarction; Renal failure; type 1 diabetes; type 2 diabetes
• ISSN: 1462-8902; 1463-1326; 1463-1326
• DOI: 10.1111/dom.15883

Glucagon‐like peptide‐1 receptor agonist (GLP‐1RA) medications have been shown to be effective in achieving optimal glucose control and reducing all‐cause death, cardiovascular death, nonfatal myocardial infarction, hospitalization for heart failure, and end‐stage kidney disease in individuals with type 1 (T1D) and type 2 diabetes (T2D). However, use of these medications has been associated with increased hypoglycaemia risk in patients treated with concomitant antihyperglycaemic medications. The risk is particularly high in patients with T1D due to their loss of glucagon counter‐regulatory response. This article reviews the effect of GLP‐1RA formulations on the development of hypoglycaemia in individuals with T1D and T2D treated with insulin therapy, discusses the benefits of continuous glucose monitoring with GLP‐1RA treatment, and presents strategies for safely initiating GLP‐1RA therapy in these individuals. Continuing Medical Education: Please visit https://health.learning.wiley.com/courses/dom-26s7 to complete an accredited learning activity for this article and receive 2.0 AMA PRA Category 1 Credit™.