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endocrine:glp1:liraglutide

Liraglutide

Liraglutide is a once-daily GLP-1 receptor agonist used for Type 2 Diabetes, obesity, and cardiovascular risk reduction.

Brand names:

  • Victoza (Type 2 Diabetes)
  • Saxenda (Obesity)

GLP-1 Receptor Agonists Overview

Mechanism of Action

Liraglutide activates the GLP-1 receptor.

Effects:

  • Increases glucose-dependent insulin secretion
  • Decreases glucagon secretion
  • Slows gastric emptying
  • Increases satiety
  • Promotes weight loss

Net clinical effects:

  • Decreases HbA1c
  • Reduces body weight
  • Reduces major adverse cardiovascular events

Low hypoglycemia risk unless combined with insulin or sulfonylureas.

Indications

Type 2 Diabetes Mellitus

  • Glycemic control
  • Cardiovascular risk reduction

Obesity ★

  • Chronic weight management
  • Reduces visceral adiposity
  • Improves metabolic risk factors

Atherosclerotic Cardiovascular Disease (ASCVD) ★

Liraglutide reduces:

  • Myocardial infarction
  • Stroke
  • Cardiovascular death

Cardiovascular Modules

Major Trial

LEADER Trial:

  • Reduced cardiovascular death
  • Reduced major adverse cardiovascular events
  • Demonstrated mortality benefit in high-risk patients

Dosing

  • Once-daily subcutaneous injection
  • Titrate gradually to minimize GI side effects

No oral formulation.

Adverse Effects

Common:

  • Nausea
  • Vomiting
  • Diarrhea
  • Early satiety

Serious (rare):

  • Pancreatitis
  • Gallbladder disease
  • Theoretical risk of medullary thyroid carcinoma

Contraindications

  • Personal or family history of medullary thyroid carcinoma
  • MEN2 syndrome
  • Severe gastrointestinal disease

Use caution in:

  • History of pancreatitis

Liraglutide vs Other GLP-1 Agents

Exenatide

  • Shorter-acting options available
  • Less robust ASCVD data

Dulaglutide

  • Weekly injection
  • Strong primary prevention data

Semaglutide

  • Greater weight loss
  • Oral formulation available
  • Strong ASCVD data

Liraglutide:

  • First GLP-1 to show mortality reduction
  • Daily dosing

GLP-1 vs SGLT2

Liraglutide:

  • Strong ASCVD reduction
  • Modest weight loss
  • Minimal heart failure benefit

SGLT2 Inhibitors:

  • Strong heart failure benefit
  • Strong renal protection

Clinical Pearls

  • First GLP-1 with proven CV mortality reduction
  • Daily injection
  • Useful in obesity and diabetes
  • Not a primary heart failure therapy
endocrine/glp1/liraglutide.txt · Last modified: by andrew2393cns