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Date of Award

Spring 2024

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Jaime Shaffer, PA-C

Abstract

Type 2 Diabetes Mellitus (T2DM) is a growing health concern affecting millions of people in the US, prompting the exploration of innovative pharmacotherapies such as Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs). These medications offer benefits including weight loss and improved glycemic control while limiting the concern for hypoglycemia, however, challenges in production and supply led to a national shortage. Understanding their mechanism of action, production process, and effects is crucial for optimizing patient care during this time. GLP-1 RAs act as incretin hormones, stimulating insulin release and regulating glucagon secretion, but are degraded rapidly by dipeptidyl-peptidase IV (DPP-IV). Synthetic forms resist DPP-IV and are produced using recombinant DNA technology which limits manufacturing speed. Despite their benefits, GLP-1 RAs carry adverse effects including most commonly gastrointestinal symptoms and some concerns for pancreatic and thyroid cancers though data remains inconclusive. Evaluating the risk-benefit profile is essential prior to prescribing, especially during a shortage. Strategies for navigating the scarcity include prioritizing patients, delaying initiation or titration, and considering alternative therapies. Clinicians must weigh efficacy, adverse effects, and availability when managing patients, adapting to evolving circumstances to ensure effective treatment. Understanding the complexities of GLP-1 RAs and implementing appropriate management strategies are essential for optimizing care during shortages and improving outcomes for patients with T2DM and obesity.

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Navigating Glucagon-Like Peptide-1 Receptor Agonist (GLP-1 RA) Pharmacotherapy in the Management of Diabetes and Obesity

Type 2 Diabetes Mellitus (T2DM) is a growing health concern affecting millions of people in the US, prompting the exploration of innovative pharmacotherapies such as Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs). These medications offer benefits including weight loss and improved glycemic control while limiting the concern for hypoglycemia, however, challenges in production and supply led to a national shortage. Understanding their mechanism of action, production process, and effects is crucial for optimizing patient care during this time. GLP-1 RAs act as incretin hormones, stimulating insulin release and regulating glucagon secretion, but are degraded rapidly by dipeptidyl-peptidase IV (DPP-IV). Synthetic forms resist DPP-IV and are produced using recombinant DNA technology which limits manufacturing speed. Despite their benefits, GLP-1 RAs carry adverse effects including most commonly gastrointestinal symptoms and some concerns for pancreatic and thyroid cancers though data remains inconclusive. Evaluating the risk-benefit profile is essential prior to prescribing, especially during a shortage. Strategies for navigating the scarcity include prioritizing patients, delaying initiation or titration, and considering alternative therapies. Clinicians must weigh efficacy, adverse effects, and availability when managing patients, adapting to evolving circumstances to ensure effective treatment. Understanding the complexities of GLP-1 RAs and implementing appropriate management strategies are essential for optimizing care during shortages and improving outcomes for patients with T2DM and obesity.