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The primary mechanisms of action include: Enhancing insulin secretion from pancreatic beta cells in a glucose-dependent manner, which helps lower blood glucose levels without causing excessive hypoglycaemia Suppressing glucagon release from pancreatic alpha cells, reducing hepatic glucose production Slowing gastric emptying , which prolongs the feeling of fullness after meals Acting on appetite centres in the brain , particularly the hypothalamus, to reduce hunger and food intake Most GLP-1 receptor agonists are administered via subcutaneous injection, with dosing frequencies ranging from once daily to once weekly depending on the specific formulation

Most hepatic improvements correlate with the degree of weight loss, with limited evidence for weight-independent antifibrotic effects

Yang J, Park OJ, Kim J, Han S, Yang Y, Yun CH, et al

They can also be used safely at low eGFR, and initiation or continuation in dialysis patients is associated with lower cardiovascular risk and mortality

Indeed, results from clinical studies examining the efficacy of exenatide or liraglutide as monotherapies or in combination with oral antidiabetes medications in patients with T2D have shown that, at concentrations sufficient to reduce HbA1c, no significant differences in the incidence of major [events that resulted in loss of consciousness, seizure, coma or other mental status change consistent with neuroglycopaenia which resolved after administration of glucagon or glucose or events those that required third party assistance because of severe impairment in consciousness or behaviour and had a glucose value of less than 54 mg/dl (3 mmol/l)] or minor [events that had symptoms consistent with hypoglycaemia and glucose values of less than 54 mg/dl (3 mmol/l) prior to treating the episode] hypoglycaemia compared to placebo were observed (Table 1) [15,21,3740]

And those who are not ready for surgery can start with physician supervised medical weight management, which includes GLP-1 medications proven to cut body weight by 15 to 25 percent