医学
利拉鲁肽
减肥
不利影响
艾塞那肽
赛马鲁肽
2型糖尿病
低血糖
恶心
糖尿病
呕吐
重症监护医学
内科学
胰岛素
内分泌学
肥胖
作者
Brit Long,Jessica Pelletier,Alex Koyfman,Rachel E. Bridwell
标识
DOI:10.1016/j.ajem.2024.01.010
摘要
Glucagon-like peptide 1 (GLP-1) based therapies, including GLP-1 agonists, are currently in use for treatment of diabetes and obesity. However, several complications may occur with their use. This narrative review provides a focused evaluation of GLP-1 agonist therapy and associated complications for emergency clinicians. GLP-1 agonists potentiate insulin release and reduce gastric emptying and food intake. These agents have demonstrated significant improvements in glucose control in diabetics and weight loss in obese patients. The two most common agents include subcutaneous semaglutide (Ozempic, approved for type 2 diabetes, and Wegovy, approved for weight loss) and liraglutide (Saxenda, approved for weight loss, and Victoza, approved for type 2 diabetes), though an oral formulation of semaglutide is available (Rybelsus). While these drugs are associated with improved long-term outcomes, there are a variety of associated adverse events. The most common include gastrointestinal (GI) adverse events such as nausea, vomiting, diarrhea, and abdominal pain. Pancreatitis and biliary disease may also occur. Hypersensitivity including injection site reactions have been associated with use, with reports of anaphylaxis and other rashes. Renal adverse events are most commonly associated with severe GI losses. Hypoglycemia may occur when these agents are used with sulfonylureas or insulin. There is also an increased risk of diabetic retinopathy. Due to the current shortage and expense of these medications, many patients have attempted to obtain these medications from non-licensed and unregulated agents, which may be associated with increased risk of serious complications. An understanding of the indications for GLP-1 agonist use and associated adverse events can assist emergency clinicians.
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