Semaglutide, Liraglutide, Dulaglutide... Can't tell these peptides apart? Actually, they all belong to the class of glucagon-like peptide-1 receptor agonists. For people with diabetes, you may often wonder: Am I eligible for these drugs? How to use them? What precautions should I take? Let's learn about this class of medications together.

1. What are Glucagon-like Peptide-1 Receptor Agonists (GLP-1RAs)?

Glucagon-like peptide-1 (GLP-1) is a 30-amino-acid peptide hormone derived from proglucagon cleavage. It is mainly secreted by L cells in the distal intestine, α cells in the pancreas, and the central nervous system. GLP-1 exerts its biological effects by binding to the glucagon-like peptide-1 receptor (GLP-1R).

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) mimic endogenous GLP-1 to activate GLP-1R. They enhance insulin secretion and inhibit glucagon secretion in a glucose-dependent manner, delay gastric emptying, and reduce food intake via central appetite suppression, thereby achieving blood glucose lowering effects. Currently approved marketed drugs are listed in Table 1.

2 Indications (Applicable Populations)

Indicated for blood glucose control in adult patients with type 2 diabetes mellitus.

Indicated for adult patients with type 2 diabetes mellitus whose blood glucose is inadequately controlled despite treatment with metformin and/or sulfonylureas, on the basis of diet control and exercise.

Liraglutide and Semaglutide Injection are also approved for reducing the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) in adult patients with type 2 diabetes mellitus and established cardiovascular disease.

3. Adverse Reactions

In terms of safety, there is no significant difference among various GLP-1RA preparations. Gastrointestinal reactions are the most common adverse reactions, mostly mild to moderate and transient, which are tolerable in most patients. GLP-1RAs have a low risk of hypoglycemia when administered alone. Attention should be paid to allergic reactions during initial use, and injection site reactions during long-term use. For detailed adverse reactions, see Table 2.

4. Contraindications

Patients with hypersensitivity to the active ingredient or any excipients of this product.

Personal history or family history of medullary thyroid carcinoma (MTC).

Patients with multiple endocrine neoplasia syndrome type 2.

5. Management of Missed Doses

For short-acting GLP-1RAs administered multiple times daily: If a dose is missed, skip the missed dose and resume dosing according to the regular schedule.

For long-acting GLP-1RAs administered once weekly:a. If the missed dose is more than 3 days (72 hours) before the next scheduled dose, administer the dose as soon as possible after discovery.b. If the missed dose is less than 3 days (72 hours) before the next scheduled dose, do not make up the dose; resume dosing according to the regular schedule at the next scheduled time.

In all cases, patients may resume their regular once-weekly dosing schedule. If needed, the weekly dosing day may be changed, provided that more than 3 days (72 hours) have passed since the last dose.

6. Storage Instructions

GLP-1RAs should be refrigerated at 2°C to 8°C and must not be frozen. After initial use, they can generally be stored at room temperature or refrigerated at 2°C to 8°C. Keep the pen cap closed to protect from light. For specific storage conditions of each drug, see Table 3.