John B. Buse, MD, PhD, discusses type 2 diabetes in this CME activity titled "Exploring the Science and Practice of GLP-1 Receptor Agonists: An Update on Current and Emerging Evidence." For the full presentation, downloadable infographics, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2oL19BK. CME credit will be available until October 21, 2020.

1. ADA 2019 Treatment Algorithm1-6
TherapeuticBenefits11-18
GLP-1 RAs, the First Injectable Agent1,7-10
Established ASCVD or CKD Without established ASCVD or CKD
Cost is a major issue: SU and/or TZD
If A1C remains above target, despite metformin and lifestyle modifications:
ASCVD
predominates
HF or CKD
predominates
Need to minimize
hypoglycemia
Need to minimize
weight gain
GLP-1 RA
SGLT2i
GLP-1 RA
SGLT2i
SGLT2i DPP-4i GLP-1 RA
SGLT2i TZDGLP-1 RA
Despite Tx
GLP-1 RA
Despite Tx
Basal insulin
Factors to Consider1,12-18,29-32
Potential for
weight loss
High efficacy
Noneedforroutine
BGmonitoring
Somecanbe
takenanytime
Low
intrinsic risk
of hypoglycemia↓ systolic BP
Semaglutide
oral tablet
Liraglutide,
lixisenatide
Dulaglutide, exenatide ER,
semaglutide injection
Exenatide BID
2x/day 1x/day 1x/day1x/week
How
When
What
Dosing Characteristics12-28
GLP-1 RA SGLT2i
Consider insulin as first
injectable if
• A1C is very high
• Evidence of catabolism
• Type 1 diabetes possible
Exploring the Science and Practice of GLP-1 Receptor Agonists
Full references, accreditation, and disclosure information available at PeerView.com/YYH930.
GLP-1 Receptor Agonists and Current Clinical Guidance

2. Major Classes of
Glucose-Lowering Agents1,12-18,33-43
Cardiovascular and
Other Outcomes45-53
SGLT2 inhibitors
TZDs
Biguanides
Insulin
DPP-4 inhibitors
GLP-1 RAs
Sulfonylureas
GLP-1 Mechanism
of Action44
GLP-1 RA
Heart
Cardioprotection
Coagulation
InflammationBody weight
Postprandial
lipids
Glucose
Blood
pressure
Natriuresis
Diuresis
Hypoglycemia
Platelets
Intestine
α-cell
↓ Glucagon secretion
β-cell
↑ Insulin secretion
↑ Insulin biosynthesis
↓ Apoptosis
Fat and
other tissuesBrain
A1C Hypoglycemia MACE Nephropathy All-cause/CV mortality
Blood vessel
Kidney
Exploring the Science and Practice of GLP-1 Receptor Agonists
Full references, accreditation, and disclosure information available at PeerView.com/YYH930.
The Science of GLP-1 Receptor Agonists

3. Adjuncttodiet
&exercise
Review
Im
plem
ent
Monitor
Agree
CreateConsider
Assess
Discussion Points12-18,55
Some can be
taken any time
Use pen
injectors
Use small
needles
Glucose monitoring
not routine
May prevent
heart attacks
Injections are
subcutaneous
GoalsofCare1,54
Lixisenatide
Exenatide BID
Exenatide ER
Liraglutide
Dulaglutide
Semaglutide
Reductionof
CVendpoints
SafetyandPrecautions12-18
Thyroid
C-cell
Pancreatitis
Immunogenicity
Gallbladder
disease
GIdisease
ESRD
Hypoglycemia Anaphylaxis
Injection site
Retinopathy
Pharmacology12-18,58-61
Pharmacokinetics
Information
barriers
Personal
motivation
barriers
Behavioral
skills barriers
A1C
Social
motivation
barriers
Short acting
Long acting
Structure
Exendin-4 based
GLP-1 based
Molecular Size
Small
Large
Adherence and Persistence62-65
Diabetes
medication
adherence
Current Indications12-18,56,57
Exploring the Science and Practice of GLP-1 Receptor Agonists
Full references, accreditation, and disclosure information available at PeerView.com/YYH930.
Shared Decision-Making and GLP-1 Receptor Agonists