Table 2. Summarizing the distinctions between GLP-1-RAs in different categories.

GLP-1-RAs: Glucagon-like peptide-1 receptor agonists; GI: Gastrointestinal.

Category	Aspect	Details
Efficacy Differences	Glycemic Control	Research has demonstrated that semaglutide is more effective than other GLP-1-RAs in decreasing HbA1c levels [58]. The SUSTAIN-7 study found that semaglutide 1.0 mg reduced HbA1c by 1.8% more than dulaglutide 1.5 mg, which reduced it by just 1.4% [58].
	Weight Loss	In clinical trials, semaglutide had the most dramatic weight loss results, with reductions of up to 15% of the individual's baseline body weight [59]. Both liraglutide and dulaglutide have been proven to cause weight reduction, generally between 3 and 9 percent of the person's starting weight [30].
	Cardiovascular Outcomes	Liraglutide, semaglutide, and dulaglutide improve cardiovascular health [79]. Semaglutide reduced MACE by 26%, while liraglutide decreased it by 13%. The degree of the influence may vary [79,86].
Safety and Tolerability	Gastrointestinal Side Effects	The prevalence and severity of gastrointestinal (GI) side effects caused by GLP-1-RAs may vary [72]. In compared to dulaglutide, they had a somewhat greater incidence of nausea and vomiting [73]. Semaglutide and liraglutide are also linked to this condition.
	Injection Site Reactions	All agents are normally moderate; however, the frequency might vary substantially amongst agents [15].
	Pancreatitis and Thyroid Safety	It has been shown that there are no major differences between agents [87]
Pharmacokinetics and Dosing	Half-life and Dosing Frequency	Exenatide is taken twice a day and has a short duration of effect (4-6 hours) [88]. Liraglutide is suggested to be taken one daily [89]. Semaglutide, dulaglutide, and exenatide are long-acting medications that are administered once weekly [15].
	Route of Administration	Most GLP-1-RAs are given subcutaneously [15]. Semaglutide is now the sole oral GLP-1-RAs available on the market [32].
	Size and Structure	Exenatide and liraglutide are medicines created from modified GLP-1-RAs or exendin-4, providing more examples of such medications [90]. Both dulaglutide and semaglutide have bigger molecules, which results in a longer half-life [91].
Cost Differences		Newer medications, such as semaglutide, are frequently more expensive than older choices, such as liraglutide and exenatide [92]. Cost concerns are likely to have an influence on the process of making treatment choices and access to therapy [73,93].
Special Population	Renal Impairment	Exenatide doses must be adjusted for patients with mild renal impairment. However, it is not suggested that those with severe renal impairment use this medication [57]. Individuals with kidney issues, particularly those with end-stage renal illness, may be administered liraglutide, dulaglutide, and semaglutide with no further dosage adjustments [57].
Considerations	Cardiovascular Risk	Liraglutide, semaglutide, and dulaglutide have beneficial effects on the cardiovascular system and may be favored for patients at high risk of cardiovascular problems [94].