doi:10.1074/jbc.R113.458810
Because the review of 48 studies, although comprehensive, looked at a wide and diverse group of people -- from those with conditions such as diabetes and kidney disease, and those with different starting and end points and who took different medications -- the conclusions drawn also highlight its limitations
Still, with over 4,600 new diabetes cases, 23 randomized controlled trials, and more than 150,000 participants, the signal is strong

Clinical scenarios warranting consideration of GLP-1 therapy include: Type 2 diabetes management : Per ADA 2024 Standards of Care, GLP-1 RAs may be considered as initial therapy in patients with established atherosclerotic cardiovascular disease (ASCVD), high ASCVD risk, chronic kidney disease (CKD), or heart failure, or as add-on therapy when glycemic targets aren't met Established cardiovascular disease : Several GLP-1 receptor agonists have demonstrated cardiovascular risk reduction in patients with type 2 diabetes and established ASCVD Chronic kidney disease : While SGLT2 inhibitors are generally prioritized for CKD with type 2 diabetes when eGFR allows, GLP-1 RAs may provide complementary benefits Obesity with complications : When lifestyle interventions produce insufficient weight loss in patients with obesity-related comorbidities Important safety considerations include: Contraindications : Personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2
