Characteristics of Injectable Non-Insulin Antihyperglycemic Medications

Glucagon-like peptide-1 (GLP-1) agonists

Low risk of hypoglycemia; may promote modest weight loss

Increased risk of pancreatitis

Thyroid C-cell tumors (medullary carcinoma) noted in rodents

To minimize nausea and vomiting, start at the lowest dose and titrate according to manufacturer's recommendations

May improve hepatic fat content and fibrosis, MASLD, and MASH

Albiglutide

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Dulaglutide Dulaglutide

May decrease major adverse cardiovascular events in patients with high risk of cardiovascular disease

ExenatideExenatide

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Exenatide, once a weekExenatide, once a week

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LiraglutideLiraglutide

May decrease major adverse cardiovascular events and cardiovascular death in patients with high risk of cardiovascular disease

LixisenatideLixisenatide

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Semaglutide*Semaglutide*

Semaglutide is associated with increased progression of diabetic retinopathy

May decrease major adverse cardiovascular events and cardiovascular death (oral semaglutide) in patients with high risk of cardiovascular disease

Amylin analog

PramlintidePramlintide

For use in combination with insulin, but injected using a separate syringe

May need to adjust insulin dose to avoid hypoglycemia

Nausea common but declining with time

May promote modest weight loss

Dual incretin agonists (glucose-dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor agonist

TirzepatideTirzepatide

Promotes weight loss

Causes GI symptoms, including decreased appetite, diarrhea , nausea, abdominal pain and increased amylase and lipase

To minimize symptoms start at lowest dose and titrate according to manufacturers recommendations

Thyroid C cell tumors noted in rodents

Cases of pancreatitis have been reported