AbstractSince the first glucagon‐like peptide 1 (GLP‐1) receptor agonist (GLP‐1RA) was approved in 2005 (exenatide twice daily) for type 2 diabetes (T2D), the class has developed with newer compounds having more pronounced effects on glycaemic control and body weight. Also, administration regimes have become more convenient with once weekly injections, and recently an oral administration has become available. Large‐scale randomized controlled cardiovascular (CV) outcome trials (CVOTs) have shown that GLP‐1RA therapy can reduce the risk of CV disease (CVD) in high‐risk individuals with T2D. In addition, GLP‐1RAs may have renal benefits driven by new‐onset macroalbuminuria, although no effect on hard renal endpoints has been found. Subsequently, the place for GLP‐1RA therapy has changed over recent years, with most societies endorsing GLP‐1RA therapy in patients with established or high risk of CVD independently of glycaemia. Initiation of GLP‐1RA therapy can be complex due to differences in efficacy, side effects and safety profiles as well as administration forms within the class. Implementing guideline recommendations into ideal patient selection may be challenging both in specialty and non‐specialty settings. To ensure adequate and proactive use of modern glucose‐lowering medications in the treatment of T2D, it is essential to recognize patients with high risk or documented CVD. The present review provides an overview of the efficacy and benefits of the currently available GLP‐1RA compounds. Furthermore, we review the results from recent large‐scale CVOTs in a clinical context and suggest improving the implementation of GLP‐1RA therapy across specialties to improve overall patient selection.

中文翻译：

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了解 GLP-1RA 治疗的地位：将 2 型糖尿病治疗指南转化为日常临床实践和患者选择

摘要自 2005 年第一个胰高血糖素样肽 1 (GLP-1) 受体激动剂 (GLP-1RA) 被批准用于治疗 2 型糖尿病 (T2D)（艾塞那肽每日两次）以来，该类药物已开发出对血糖影响更显着的新型化合物控制和体重。此外，每周注射一次的给药方案变得更加方便，并且最近已经可以口服给药。大规模随机对照心血管 (CV) 结果试验 (CVOT) 表明，GLP-1RA 治疗可以降低 2 型糖尿病高危个体患心血管疾病 (CVD) 的风险。此外，GLP-1RA 可能具有由新发大量白蛋白尿驱动的肾脏益处，尽管尚未发现对硬肾终点的影响。随后，近年来，GLP-1RA 治疗的地位发生了变化，大多数社会认可 GLP-1RA 治疗已确定或高风险 CVD 的患者，与血糖无关。由于疗效、副作用和安全性以及类别内给药形式的差异，GLP-1RA 治疗的启动可能很复杂。无论是在专业还是非专业环境中，将指南建议落实到理想的患者选择中可能都具有挑战性。为了确保在 T2D 治疗中充分、主动地使用现代降糖药物，必须识别患有高风险或有记录的 CVD 患者。本综述概述了目前可用的 GLP-1RA 化合物的功效和益处。此外，我们回顾了最近在临床背景下大规模 CVOT 的结果，并建议改进跨专业 GLP-1RA 治疗的实施，以改善整体患者选择。