TABLE 13.

Considerations for Drug Initiation and Monitoring in Patients Starting a GLP-1RA With Demonstrated CV Benefit

■ If A1C well-controlled at baseline, or known history of frequent hypoglycemic events, reduce dose of sulfonylurea by 50% or basal insulin dose by 20% when starting therapy.

■ Discontinue DPP-4 inhibitor before starting (if applicable)

■ Start at lowest dose and up-titrate slowly to mitigate nausea to the doses used in CV outcome trials*

■ Instruct patients to more closely monitor glucose at home for the first 4 weeks of therapy

■ Advise patients to undergo appropriate, guideline-recommended eye examinations before starting therapy if not done within the last 12 months

■ Increase in diabetic retinopathy complications (for semaglutide)

^*Higher doses of GLP1-RA can sometimes be used for weight loss, but have not been shown to offer additional CV risk reduction.

A1C = hemoglobin A1C; CV = cardiovascular; DPP4 = dipeptidyl peptidase-4; GLP-1RA = glucagon-like peptide-1 receptor agonist.