Intended for healthcare professionals


Helping patients make sense of the risks of taking GLP-1 agonists

BMJ 2013; 346 doi: (Published 10 June 2013) Cite this as: BMJ 2013;346:f3692
  1. Victor M Montori, professor of medicine
  1. 1Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55902, USA
  1. montori.victor{at}

Tough when benefits and harms are unclear

There are three reasons to lower glycaemia in patients with type 2 diabetes: to treat the symptoms of hyperglycaemia; to prevent symptomatic hyperglycaemia; and to reduce the risk of developing complications associated with diabetes. Regulatory agencies approve antihyperglycaemic agents because they prevent and treat hyperglycaemia. The US Food and Drug Administration now requires drug companies to show that their antihyperglycaemic drugs do not increase a patient’s risk of developing cardiovascular disease. Currently, however, no regulatory agency requires evidence of a drug’s efficacy in reducing the risk of developing complications of diabetes.

Does the use of antidiabetic drugs have any benefits in patients with asymptomatic type 2 diabetes? It is possible that lowering glycaemia, regardless of the approach, reduces the risk of microvascular and cardiovascular complications, but this remains uncertain, despite testing in contemporary trials that have enrolled tens of thousands of patients.1 Furthermore, comparative effectiveness studies have shown no antihyperglycaemic drug to be more beneficial in this regard than any other.2 Evidence from long term follow-up of patients in the UK Prospective Diabetes Study suggests that cardiovascular complications might be reduced by preventing hyperglycaemic symptoms.3 Considerable uncertainty exists, however, in applying this evidence to patients who are at risk of cardiovascular complications but who quit smoking and adhere to low dose aspirin, standard or high dose …

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