6.1.2.6 GLP-1 mimetic (injectable)

Choice	Drug	Dosage
1st choice	Liraglutide injection 6mg/mL	Dose: Initially 0.6mg once daily, increased after at least 1 week to 1.2mg once daily Renal impairment – see BNF
2nd choice (where weekly injection is preferred)	Dulaglutide ▼1.5mg/0.5ml solution for injection	Dose: Add-on therapy: 1.5mg once weekly Renal impairment – see BNF

Prescribe as per NICE Guideline NG28 recommendations. See also NICE Algorithm for blood glucose lowering therapy in adults with type 2 diabetes.
To prevent waste, please avoid prescribing large quantities – GLP-1 mimetics require refrigeration and are expensive. One month’s supply should be adequate for most patients.
Stopping rules with GLP-1 mimetics: NICE state only continue GLP‑1 mimetic therapy if the person with type 2 diabetes has had a beneficial metabolic response (a reduction of at least 11 mmol/mol [1.0%] in HbA1c and a weight loss of at least 3% of initial body weight in 6 months).
Gastric emptying may be delayed. Therefore the rate and extent of absorption of other oral drugs administered at the same time may be affected.
Doses of concomitant sulfonylurea may need to be reduced when a GLP-1 mimetic is started.
Upper gastrointestinal side effects such as nausea are common with GLP-1 mimetic therapy.
There are rare reports of acute pancreatitis in patients using these drugs. GLP-1 mimetics should be avoided in patients considered to be at high risk of pancreatitis. Patients and their carers should be told how to recognise signs and symptoms of pancreatitis.
Thyroid adverse events, including increased blood calcitonin, goitre and thyroid neoplasm, have been rarely reported in clinical trials with liraglutide, particularly in patients with pre-existing thyroid disease.

Cautions

Diabetic ketoacidosis has been reported in patients with type 2 diabetes on a combination of a GLP-1 receptor antagonist and insulin who had doses of concomitant insulin rapidly reduced or discontinued. See MHRA for further details.