Current Information on GLP-1

Information on GLP-1Glucagon-like peptide-1 (GLP-1) receptor agonists are arguably the
medication class of the moment. First used to treat type 2 diabetes, then people with
overweight or obesity, these agents have been making headlines for the past few years.
Yes, they can be costly, and there are reports of side effects, but those two factors
have not appeared to dampen the enthusiasm around the GLP-1 receptor agonists.

—Brain effects. GLP-1 receptor agonists can cross the blood-brain barrier, work

on the brain’s satiety center, and decrease the desire for food. Recent evidence suggests
that these medications can also reduce inflammation in the brain, prompting research
on whether they will have a role in treating Parkinson’s disease or Alzheimer’s
disease in the future.

Improved cardiovascular outcomes. It’s not completely clear how GLP-1 receptor agonists
can improve cardiovascular health, although leading theories include increased
vasorelaxation, protection against injury from ischemia and reperfusion, and/or
improvements in myocardial contractility. Other physiologic effects of these agents,
including weight loss, blood pressure control, and lower risk for severe hypoglycemia
probably also contribute to beneficial cardiovascular effects.

Slower peristalsis and gastric emptying. GLP-1 receptor agonists slow gastric emptying,
which is associated with weight loss. While this factor can cause adverse effects in some
patients, many people return to normal within weeks of starting the medications. The
agents also slow gastric motility by decreasing peristalsis and slowing activity of the
pylorus, the opening between the stomach and duodenum, which delays gastric emptying.

Blood glucose control. The GLP-1 receptor agonists release the body’s own insulin “with a
low incidence of hypoglycemia, which is an Achilles heel of traditional insulin use.” They
also decrease glucagon release by pancreatic cells and help maintain glucose
homeostasis after eating.

Liver, kidney, and systemic effects. GLP-1 receptor agonists bind to receptors located
throughout the body. For example, in addition to the pancreas, brain, heart, and stomach
GLP-1 receptors are found on cells in the lung, gastrointestinal tract, kidney, and liver.
Experts are reporting beneficial effects on the kidney and liver associated with the GLP-1
receptor agonists.

Facilitate weight loss. GLP-1 receptor agonists facilitate weight loss by slowing stomach
emptying and stimulating brain areas that control appetite, including promoting a feeling
of satiety.

Possible future indications. Researchers are investigating new, potential roles for treatment with GLP-1 receptor agonists, including treating alcohol use disorder or for reducing the risk of colorectal cancer. 

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