Most medical practitioners will make metformin their first choice as this has become the standard of care and is a very effective and inexpensive choice for beginning the therapy. The dilemma comes when a patient is no longer controlled on metformin alone. Newer ADA and AACE guidelines prescribe diverse choices for second line therapy, including sulfonylureas, dpp4-inhibitors, basal insulin, and glp-1 analogs, each with their inherent advantages and disadvantages.

The sulfonylureas are an inexpensive choice, but have some problems including weight gain, beta cell burnout and hypoglycemia, and basal insulin has the similar possibilities of weight gain and hypoglycemia, especially at the high doses usually given to our type 2 patients. The DPP-4 inhibitors work to increase the amount of native GLP-1 that remains intact for use in the body and is often construed as an oral form of GLP-1 but the DPP-4 effect is limited by the amount of native GLP-1 left in the body and we see most of the effect on the increasing first phase insulin release and decreasing glucose release from the liver. The GLP-1 analogs deliver a synthetic equivalent to native GLP-1 and so the effect is often greater that any of the other classes without the risks that we discussed, however there is often hesitation to begin GLP-1 analog therapy from prescribers and patient due to the method of delivery.

Our goal in this special edition is to give you the rationale and tools to successfully get your patients on track to better glucose control by using a GLP-1 analog.

We have spent some time talking to physicians, nurse practitioners and diabetes educators in order to provide you with the best ideas of how you can move your patients over to GLP-1 therapy. In addition we will also give you some help in explaining the value of this class of medications, and exactly how these medications work to make it even easier for you to explain.