Glucagon-like peptide-1 analogues for type 2 diabetes

Case scenario

A 58 year old woman attends a diabetes clinic with type 2 diabetes of seven years’ duration and no history of macrovascular disease. She is obese (body mass index 37), but says she eats a healthy diet and describes this. Her blood pressure is 134/78 mm Hg, and she has microalbuminuria, but normal renal function and a lipid profile within target levels ranges. She is taking simvastatin 40 mg daily and perindopril 4 mg daily. Glycated haemoglobin (HbA_1c) is 8.3% despite treatment with metformin 850 mg three times a day and gliclazide 160 mg twice a day. How would you best manage her hyperglycaemia? (The table⇓ shows the drug treatment options.)

After discussion with the patient of the benefits and risks of the available treatment options (including the “do nothing” option, risks of hypoglycaemia, and effects on body weight), you agree on a glucagon-like peptide-1 (GLP-1) analogue (exenatide or liraglutide).