Are there differences in the efficacy of once-weekly GLP-1RAs in patients with type 2 diabetes?

Several long-acting glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been developed for the treatment of people with type 2 diabetes (T2D). This narrative review compares the relative efficacy of these agents according to glycemic and nonglycemic endpoints in key clinical trials. Primary reports of clinical trials used to support the regulatory applications of once-weekly GLP 1RAs were selected. These articles were critically reviewed for information on efficacy, and comparative assessments were made where possible. The estimated treatment differences for once-weekly GLP-1RAs versus placebo showed that all these agents are effective in reducing glycated hemoglobin (HbA1c). Variations in efficacies of other endpoints were also evident, but no overall pattern emerged. Two head-to-head trials showed that once-weekly semaglutide 1.0 mg was more effective than once-weekly exenatide 2.0 mg (treatment difference: 0.62%; p < .0001) and dulaglutide 1.5 mg (treatment difference: -0.41%; p < 0.0001). Similar trends were evident with bodyweight reductions. Once-weekly GLP-1RAs are a good therapeutic option for patients with T2D. There are differences between the glycemic and nonglycemic efficacies of these agents that, along with adverse event profiles, need to be considered by nurse practitioners when selecting a GLP-1RA for an individual patient.