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1yr
GLP-1 RAs: mechanisms underlying glucose control, weight loss, and CV risk reduction

Glucagon-like peptide-1 (GLP-1) is a gut hormone released in response to food intake. Initial studies of GLP-1 focused on its role in stimulating insulin secretion, suppressing glucagon secretion, and slowing gastric emptying, which has marked effects on postprandial glycemic excursions. Given the effects of GLP-1 on plasma glucose, GLP-1 receptor agonists (RAs) initially emerged as treatments for type 2 diabetes.

Because GLP-1 reduces appetite and increases satiety, certain GLP-1 RAs are used for weight loss/management in patients who are obese or overweight and have at least 1 weight-related comorbidity. Interestingly, GLP-1 RAs promote weight loss while reducing the glycemia level, which in turn limits glucosuria and should therefore have been associated with weight gain. The appetite-suppressing effects of GLP-1 RAs are hypothesized to involve interaction with key neural circuits in specific brain regions and circuits involved in the homeostatic or hedonic regulation of energy household and food intake.

While GLP-1 RAs modify cardiovascular (CV) risk via glucose control and weight loss, they may have other cardioprotective effects. There is increasing evidence that GLP-1 RAs reduce CV inflammation. GLP-1 RAs may also modify CV risk by increasing natriuresis and diuresis, lowering blood pressure and postprandial lipids, and inhibiting coagulation.

The GLP-1 RA semaglutide recently became the first weight-loss medication approved to reduce the risk of major adverse cardiovascular events (MACE) in adults with established CV disease and overweight or obesity. This approval was based on the results of the randomized, placebo-controlled SELECT trial (NCT03574597).

What percentage of your patients are overweight or obese with established CV disease? Would you recommend a GLP-1 RA for these patients?

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  • 1yr
    60-70 percent of my patients are overweight or obese and about 50 percent of them have cardiovascular disease. I recommend and prescribe GLP1 or GLP/GIP to all of them.
  • 1yr
    i love glp-1 drugs for my obese patients and lots of news coming out about other benefits from heart to brain to longevity
  • 1yr
    60-70 percent of my patients are overweight and obese with niddm ,htn,hyperlipdemia and semaglutidw and zebound help to correct their glucose,lose weight and reduce there htn.
  • 1yr
    I use GLP-1 drugs in probably 20% of my patients. Nearly all are also diabetic if all the testing is done - most meet criteria for both DM and Weight loss indications. The main prohibitive issue remains cost.
  • 1yr
    Like many others, a large portion of my endocrine patients are overweight or obese, 75% I estimate, with Medical in CA, Wegovy is covered and I have a large number on that med who do not have diabetes and those with type, I have a large % on Trulicity,’Ozempic or Mounjaro
  • 1yr
    most type2 diabetics are obese and probably 30% of non diabetics are obese with CVD risk or conditions. Often recommend GLP1 agonists, but most patients find they don't have insurance coverage and thus cannot afford it. Regrettably, some patients have resorted to questionable compounding pharmacies/programs, which I discourage.
  • 1yr
    60 % of patients are overweight and many of them would benefit from GLP1. the cost is the barrier although some are getting syringes compounded at clinics that will send it over.
  • 1yr
    Approximately 55% of my patients are obese and at least 25% of them are already on a GLP-1, (approx. 20% of the other patients have requested it, but are unable to afford the cost/co-pay). I usually recommend GLP-1 (specifically tirzepatide) to majority of my patients who are obese.

    Ferhatbegović L, Mršić D, Macić-Džanković A. The benefits of GLP1 receptors in cardiovascular diseases. Front Clin Diabetes Healthc. 2023 Dec 8;4:1293926. doi: PMID: 38143794; PMCID: PMC10739421.
  • 1yr
    80 percent diabetics i treat are obese with sleep apnea and hypertension,that is why i use GLP-I for weight loss and glycemic control
  • 1yr
    About 50 percent
    I would recommend to most of my patients
  • 1yr
    My practice has about 50-60% type 2 diabetes - and most of these patients will have a BMI > 30. In addition, I see a lot of patients who do not have diabetes but are seeing me for their obesity. If my patients have CAD and/or CKD I definitely prescribe them GLP1 agents or GLP/GIP. There is so much evidence now that this helps patients. I have many patients who have shown improvement with their fatty liver, sleep apnea, and really a better sense of well being because of GLP-1 or GLP/GIP use and weight loss
  • 1yr
    The majority of our patients are overweight and obese, over 40% have cardiovascular disease. I frequently recommend GLP-1 therapy to these patients.
  • 1yr
    about 30 percent
    yes as long as they do not have any contraindications and have the right insurance coverage
  • 1yr
    30% of my patients would be considered obese and could benefit with diet and exercise along with appetite suppressant like GLP-1. Weight loss would help with CV risk reduction also.
  • 1yr
    Over 70% are obese, but it depends on how you define established CV disease Does a patient with a calcium core >0 qualify? If so, probabley >50% have this.
  • 1yr
    I practice in the diabetic belt with 40 percent of my patients who qualify for GLP-1s, those with diabetes and non diabetics with CV risk factors. GLP-1s have been a tool to lower MACE in this patient population.
  • 1yr
    Close to 50% obese and about 25% of those obese patients have CV diagnsis. GLP-1 tx option is optimal for those with weight problem with high risk of CV risk or even with established CV dx's, to lower the risk and improve their current comorbidities, either DM2, renal...
  • 1yr
    Over 80% are overweight or obese, with about 5% of those have CVD. Definitively do prescribe GLP-1 ra.
  • 1yr
    I would guess at least 50% of my patients are overweight and meet qualifications for GLP-1 analogs. I typically recommend these medications but find insurance coverage is limiting them.
  • 1yr
    35-40 % of my patients are obese. Many of them have weight related comorbidities including OSA, MASH and other liver disease, HTN, DJD. i would recommend GLP1 for up to 75 % of these patients.
  • 1yr
    Only about 10% of my patients with overweight or obesity have been diagnosed the CVD. I encourage male patients approaching 65 to consider the free CVD screening that Medicare offers. For all of my patients with obesity and CVD, and if they are a candidate for GLP-1s, I definitely recommend a GLP-1.
  • 1yr
    I think my population of patients with obesity that have established cardiovascular disease is about 30-40 %, Glp-1 ra is a good choice for them , to reduce cv risk and other risks associated with obesity , the problem is the price and coverage of these medications .
  • 1yr
    I agree with above comments have to say my patient population is at least 45 % obese and at least 15 % of these morbid with estimated DM type 2 over 40 % and pre-diabetes. GLP- 1 have been God sent not only for glycemic control particular post prandial as well as beneficial for CV protection BP control and lowering hypertension and of course weight reduction. Issues of vaginitis / balanitis have occurred but relatively low. My issues are more with insurance coverage although this has gone down I have not had a Fournier necrosis luckily.
  • 1yr
    40 percent of my patients have Type 2 diabetes and /or obesity. I encourage all my patients with obesity and most of my patients with diabetes to be on GLP1. We try very hard to get these medications authorized for our patients and are successful 90 percent of the time. Supply issues is another problem with these meds
  • 1yr
    essentially anyone that is obese can qualify, would give universally if the coverage were better. that's really the only limitation. I will give to anyone who is obese and can get it covered.
  • 1yr
    Approval of the GLP-1 for obese pts with CV risk is a block buster landmark in the history of the practice of medicine and recently Wegovy has been approved by CMS for the same have been using the GLP-1 for some time for the diabetic pts and the outcomes in the trials and the real time have been phenomenal with around 40% obesity in US and signficant CV in that population it will bring the paradigm shift in how we manage these pts Overall it is the weight loss which is the pivotal outcome with these pts that that imparts all the CV benefits and now natruresis and lipid improvement and eventual BP improvement also contributes to it .In my practice about 40 percent obese pts have CVD and with this indication have been using it more and more but it is still quite a challenge to get these meds approved and still have signficantly higher copay but it is worth the effort but we have been mindful of the fact that you still need a good diet and exercise program if not implemented properly the desirable efficacy is not going to be there
  • 1yr
    Cardiovascular disease is not top of mind for me by prescribing GLP-1 agonist. If I focus on my population of patients with known heart disease, if they have the comorbidity of diabetes, overweight or obesity, I will definitely recommend it. I would estimate the percentage of patients that fall into this category to be over 75%.
  • 1yr
    Over 40% of my obese pts haveh/o established CV disease. I discuss GLP-1 analogs usually with all my pts who can benefit from GLP-1 therapy but only a few pts have the medications on formulary and able to start the medication
  • 1yr
    Unfortunately the majority of my patients are overweight and obese with cardiovascular disease. I recommend GLP-1 to majority of my patient’s.

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