Thomas B. Repas. Managing Loss of Glycemic Control in Middle-Aged Patients With Diabetes: The Role of GLP-1 Receptor Agonists in Combination-Therapy Regimens. J Am Osteopath Assoc 2014;114(5_suppl_2):S14–S21. doi: 10.7556/jaoa.2014.085.
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Middle-aged patients with type 2 diabetes mellitus may have languished on monotherapy or a stable therapy for a substantial period without reconsideration of comorbidities or current control of glycated hemoglobin A1c (HbA1c). In many patients who lose glycemic control, postprandial hyperglycemia has not been addressed. This is especially true when HbA1c levels are close to—but not at—goal. Glucagon-like peptide-1 receptor agonists are injectable agents that can be added to oral therapy to address postprandial hyperglycemia. These agents may be a useful alternative to insulin therapy as add-on therapy when dual oral therapy is no longer sufficient and additional glucose lowering is required. Compared with insulin, glucagon-like peptide-1 receptor agonists have provided comparable glucose lowering with less hypoglycemia and without weight gain.
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