type 2 diabetes mellitus ( t2 dm ) has become a worldwide epidemic . it is estimated that 60% of the world 's diabetic population is in asia .
this rapid increase in the prevalence of t2 dm in asia has been fuelled by urbanization , economic growth and associated changes in diet and physical activity levels .
specifically , in korea , data derived from the korean national health and nutrition examination survey shows that t2 dm prevalence has increased moderately over the last decade from 7.7% in 2001   to 10.2% in 2010 .
the most recent data report that the overall prevalence of diabetes in adults aged 30 years or older is 12.4% . in general , asian populations tend to develop diabetes at a younger age and at lower body mass index ( bmi ) levels than has been observed in caucasian populations .
recent research in korea has , however , revealed differences between both gender and age groups : prevalence had decreased amongst women aged 30 to 59 years ( 6.9% in 2001 to 4.5% in 2010 ) , but increased amongst males aged 60 years or more ( 15.9% in 2001 to 21.6% in 2010 ) . a similar age - related trend is also reflected in data from the korean health insurance review and assessment database , in which there were significant ( p<0.001 ) decreases in annual incidence rates in younger adults ( 20 to 49 years ) and increases in the elderly ( 70 to 79 years ) .
in recognition of the progressive nature of t2 dm , the current korean clinical practice guidelines ( korean diabetes association ) suggest a stepped interventional approach .
lifestyle modification ( which incorporates diet , exercise , and education ) remains the foundation of the current clinical guidelines .
however , because lifestyle modification alone does not enable glycemic goals to be achieved or maintained in most patients , metformin monotherapy should be added at , or soon after , diagnosis , unless there are contraindications or intolerance .
ultimately the addition of a basal insulin either alone or in combination with other agents will be required to maintain glucose control .
glycosylated hemoglobin ( hba1c ) plays an important role in monitoring and targeting glycemic control and is the gold standard index for follow - up of glycemic control .
after lifestyle modification , treatment options are stratified according to the individual 's hba1c status ; patients whose hba1c is < 8% would initially receive oral hypoglycemic agents only , those in whom it is 8% to 10% would receive oral hypoglycemic agent combination therapy with basal insulin and those whose hba1c is > 10% would receive insulin with or without oral hypoglycemic agents .
patients not at target ( ideally 6.5% ) within 2 to 6 months would receive an additional oral hypoglycemic agent ( e.g. , triple therapy ) or a multiple - component insulin regimen again with or without oral hypoglycemic agents . within these guidelines
glucagon - like peptide-1 receptor agonists ( glp-1ras ) are recognized as providing a moderate ( 0.5% to 1.0% ) reduction in hba1c , with no hypoglycemia and no weight gain . however , there are some concerns with respect to gastrointestinal ( gi ) side effects and the lack of long - term established safety profile . in this paper
we review recent data on glp-1ras to help better understand their current risk / benefit profile and provide primary care practitioners with guidance on how this evidence can inform their clinical practice .
glp-1 is an incretin hormone secreted from gi l - cells early ( within 10 minutes ) after an ingested meal .
glp-1 stimulates insulin secretion in a glucose - dependent manner , suppresses glucagon secretion , delays gastric emptying , and suppresses appetite .
this combination of effects makes a significant contribution to glucose homeostasis , particularly the control of postprandial glucose .
the incretin response is markedly attenuated in people with t2 dm , making the incretin based system an attractive therapeutic target .
however , the short plasma half - life ( 1 to 2 minutes ) of glp-1 limits its suitability as a therapeutic agent for diabetes .
incretin enhancers , including dipeptidyl - peptidase 4 ( dpp4 ) inhibitors and glp-1ras have therefore emerged as a novel class of glucose - lowering therapy . a systematic review aimed at evaluating the comparative effectiveness of these two drug classes has found both to be effective , with hba1c reductions of 0.59% to 0.90% with dpp4 inhibitors and 0.77% to 1.62% with glp-1ras .
here we focus only on the glp-1ras , which mimic the effects of endogenous glp-1 , thereby stimulating pancreatic insulin secretion in a glucose dependent fashion , supressing glucagon out - put , slowing gastric emptying and decreasing appetite .
overall , the clinical advantages of glp-1ras are established in the literature ; they provide significant improvements in glycemic control with a relatively low risk of hypoglycemia and are associated with moderate , but significant , weight loss ( up to 3 kg in some clinical trials ) . efficacy has been confirmed in a meta - analysis of 17 randomized trials comparing glp-1ras ( exenatide , liraglutide , albiglutide , taspoglutide , lixisenatide ) with placebo or an active comparator ( insulin glargine , dpp4 inhibitor , thiazolidinedione , sulfonylurea ) in patients with t2 dm and suboptimal control on one or two oral hypoglycemic agents ( metformin and/or sulfonylurea ) . although the duration of the individual trials ranged from 8 to 30 weeks , overall , in comparison to placebo , all glp-1ras reduced hba1c by approximately 1% ( treatment difference 0.47% to 1.56% ) .
body weight reduction with glp-1ras has been confirmed in a meta - analysis of 21 industry - sponsored trials comparing glp-1ras with placebo , no intervention , or other diabetes medications in overweight patients with or without diabetes ( weighted mean difference , -2.9 kg ; 95% confidence interval [ ci ] , -3.6 to -2.2 ) .
however , long - terms data on the durability of this effect are currently lacking .
in addition , glp-1ras have beneficial effects on cardiovascular ( cv ) risk factors ( body weight , blood pressure , postprandial lipids , markers of oxidative stress )   with no suggestion of increased risk of cv disease : for example , exenatide cv disease - extended events , relative risk ( rr ) 0.69 ( 95% ci , 0.46 to 1.04 ) ; liraglutide major adverse cv events , incidence ratio 0.73 ( 95% ci , 0.38 to 1.41 ) . in a recent ultrasonography study , 3 months treatment with
a glp-1ra induced a redistribution of adipose tissue deposits , which may contribute to a better cv risk profile in patients with t2 dm . there are no long - term data to assess durability of weight loss , clinically important health outcomes ( cv events , mortality ) , or safety of glp-1ras .
the results of the liraglutide effect and action in diabetes : evaluation of cardiovascular outcome results ( leader ) study , formally assessing the cv safety of liraglutide , are awaited .
control of postprandial hyperglycemia is an important aspect of overall glycemic control and may contribute to lower cv morbidity and mortality .
data suggest that reduction of postprandial hyperglycemia may be particularly beneficial for patients early in the progression of diabetes .
the relevance of postprandial hyperglycemia is heightened as hba1c levels decrease ; thus , focusing on strategies to control it may increase a patient 's ability to achieve their hba1c target .
recognizing the importance of postprandial glucose , international organizations ( american association of clinical endocrinologists / american college of endocrinology , international diabetes federation , american diabetes association ) now provide 2-hour postprandial glucose targets of between 7.8 to 10.00 mmol / l ( 140 to 180 mg / dl ) in their treatment guidelines .
data from the diabetes epidemiology : collaborative analysis of diagnostic criteria in asia ( decoda )   and diabetes epidemiology : collaborative analysis of diagnostic criteria in europe ( decode )   studies suggest that the prevalence of post - challenge hyperglycemia is higher in asian patients than it is in caucasians . in a study of 68 korean patients with well - controlled t2 dm , glycemic variability and total glucose exposure were both mostly explained by postprandial glucose .
it has been suggested that the high carbohydrate diet eaten by asians , including koreans , may increase postprandial glucose more rapidly than does a lower carbohydrate diet . in the authors ' experience , postprandial hyperglycemia continues to present a problem when determining choice of treatment in patients with t2 dm ; in korea anecdotal reports suggest that 50% to 60% of patients may be affected by postprandial glucose excursions . when lifestyle interventions have failed , the addition of oral anti diabetic agents (  glucosidase inhibitors or meglitinides ) , a dpp4 inhibitor , short- or prandial - acting glp-1ra , or short - acting insulin ( for patients already on basal insulin ) may be of benefit .
the glp-1ra class can be subdivided into two types : short - acting agonists and long - acting agonists , which each have different mechanisms of action and result in different effects on fasting and postprandial glucose levels .
short - acting glp-1ras ( exenatide twice - daily and lixisenatide once a day ) act intermittently to activate the glp-1 receptor and slow gastric emptying exerting their effects predominantly on postprandial plasma glucose .
phase ii data and the results from randomised controlled clinical trials consistently demonstrate that these glp-1ras reduce postprandial plasma glucose more effectively than they do fasting plasma glucose .
for example , adding exenatide twice - daily to basal insulin ( alone or in combination with metformin and/or pioglitazone ) , lead to significant reductions in morning and evening 2-hour postprandial excursions ( both p<0.001 vs. placebo )   whilst lixisenatide 20 g once a day has been shown to significantly reduce postprandial glucose when compared with placebo after breakfast ( p<0.0001 ) , lunch ( p<0.001 ) , and dinner ( p<0.05 ) .
it is because of this effect on postprandial glucose that short - acting glp-1ras may be considered as prandial - acting glp-1ras . in contrast
long - acting glp-1ras ( liraglutide , dulaglutide , exenatide long - acting release [ lar ] ) lead to sustained activation of the glp-1 receptor and have a greater impact on fasting plasma glucose and a lesser impact on gastric emptying owing to tachyphylaxis . to date
there have been five studies directly comparing short- and long - acting glp-1ras , each demonstrating that the latter have a lesser effect on postprandial glucose . in duration-1 ,
exenatide 10 g twice - daily had a greater effect on postprandial glucose than did exenatide lar 2 mg once weekly ( least - squares meanstandard error -6.9 mmol / l vs. -5.30.5
similar results were found in the liraglutide effect and action in diabetes ( lead ) 6 study ; the estimated difference in postprandial glucose reduction was higher with exenatide 10 g twice - daily than with liraglutide 1.8 mg once a day , when measured at breakfast ( 1.33 mmol / l , p<0.0001 ) and at dinner ( 1.01 mmol / l , p<0.0005 ) . in a study comparing lixisenatide 20 g once a day and
liraglutide 1.8 mg once a day in patients with t2 dm insufficiently controlled on metformin , more patients in the lixisenatide group achieved a 2-hour postprandial plasma glucose of < 7.8 mmol / l ( 69% vs. 29% ) . in a study
comparing once - daily lixisenatide with liraglutide in patients on optimised insulin glargine with or without metformin therapy improvement in postprandial glucose levels was significantly greater with lixisenatide 20 g once a day versus liraglutide 1.2 and 1.8 mg once a day ( p<0.0001 for both comparisons ) .
most recently , the assessment of weekly administration of ly2189265 ( dulaglutide ) in diabetes-1 ( award-1 ) study , comparing dulaglutide 0.75 and 1.5 mg once weekly with exenatide 10 g twice - daily , demonstrated significantly greater reductions in the mean of all 2-hour postprandial glucose excursions with exenatide than in the two dulaglutide dose groups ( p<0.001 for both comparisons ) .
recently published data have demonstrated differences in the efficacy of glp-1ras between asian and non - asian populations . whilst this meta - analysis included data from studies with liraglutide and exenatide
, it demonstrated a significant difference in the hba1c - lowering efficacy of glp-1ras in asians ( weighted mean difference -0.32 [ -0.64 ; 0.01 ] ; p=0.044 ) and a trend for more asian patients to achieve target hba1c goals .
nevertheless , data from a population with a significant proportion of korean patients are rare . amongst the studies included in the recent meta - analysis three included only japanese patients   whilst one included patients of asian descent , of which 17% were korean .
in addition to the study by gao et al . , four other studies , have reported efficacy data for glp-1ras in korean patients with t2 dm ( table 1 ) .
evaluated the efficacy of exenatide in asian patients with t2 dm inadequately controlled with oral agents , showing improved glycemic control ( mean hba1c reduction : -1.2% vs. -0.4% , p<0.001 ) , and greater weight reduction ( -1.2 kg vs. -0.1 kg ) compared with placebo .
shin et al .   reported the results of a retrospective cohort analysis of 52 korean patients ; 6 months ' therapy with exenatide had significantly reduced hba1c ( 8.5% to 6.7% , p<0.001 ) and body weight ( 82.3 to 78.6 kg , p<0.001 ) ; no serious adverse events were reported . of note
the patients were young ( mean age 45.1 years ) and obese ( mean bmi 30.0 kg / m ) .
2011 included chinese , indian , and korean ( 167/929 , 18% ) patients ; it demonstrated liraglutide to have a similar efficacy profile in asian patients to that seen in caucasian , african american and hispanic populations in other global liraglutide phase iii trials . in the global harmony-7 study , five of the 162 study sites were in korea .
patients who received liraglutide once a day had greater reductions in hba1c than did those who received albiglutide once weekly . of note
the patients were older ( mean age 55 years ) , had a long duration of diabetes ( mean 8.4 years ) and were obese ( mean bmi > 30.0 kg / m ) .
lixisenatide , 20 g once a day , as add - on therapy in patients with t2 dm insufficiently controlled on basal insulin ( with or without sulfonylurea ) significantly improved hba1c vs. placebo and enabled more patients to achieve hba1c target ( < 7% and < 6.5% ) .
although there was a trend towards weight loss for lixisenatide ( p=0.0857 ) in this study , the observed weight losses were small ( -0.38 kg and + 0.06 kg in the lixisenatide and placebo groups , respectively ) possibly due to the low mean baseline bmi ( 25 kg / m ) and body weight ( 66 kg ) .
fear of hypoglycemia is a major barrier to optimizing glycemic control in patients with t2 dm . hypoglycemic events increase the direct and indirect economic burden of diabetes and also have a negative impact on a patient 's quality of life and confidence in diabetes self - management ability .
preventing hypoglycemic events and the early detection of patients at high risk for hypoglycemia are important aspects of clinical care . in the recent meta - analysis by kim et al .
, there was no significant difference in the rr of hypoglycemia with glp-1ras between asian and non - asian populations ( 2.8 vs. 1.5 , respectively ; p=0.164 ) . in the study by gao et al .  
the incidence of symptomatic hypoglycemia was higher in exenatide - treated patients than those who received placebo ( 36% and 9% , respectively ; p<0.001 ) .
hypoglycemia rates ( events / patient - year ) for patients taking exenatide with metformin alone were 1.8 and this increased to 4.7 amongst those taking metformin plus a sulfonylurea .
there were no reported incidences of hypoglycemia in the retrospective cohort analysis 52 korean patients after 6 months ' therapy with exenatide .
, only two subjects in the glimepiride group reported major hypoglycemia while there were none in the liraglutide groups . in the getgoal - l - asia study 42.9% of lixisenatide - treated patients and
23.6% of those receiving placebo reported symptomatic hypoglycemia ; none of these events was severe . when patients also receiving a sulfonylurea
were excluded the incidence of hypoglycemia in the lixisenatide group was comparable to that in the placebo group ( 32.6% vs. 28.3% ) . the most frequently reported adverse events with glp-1ras are gi related and include nausea , vomiting , and diarrhea .
for example , a study of lixisenatide versus liraglutide found that the incidences of nausea ( 23% vs. 22% ) and vomiting ( 10% vs. 7% ) were similar in both groups , whereas diarrhea was more common in the liraglutide group ( 16% vs. 3% ) . a recent meta - analysis sought to interrogate the data from randomised controlled trials with glp-1ras ( liraglutide and exenatide ) and assess the impact of different doses on gi adverse events .
pairwise random - effects meta - analyses and mixed treatment comparisons found that , relative to placebo , exenatide 10 mg twice - daily is significantly more likely to cause nausea and vomiting whilst liraglutide 1.2 mg once a day is significantly more likely to cause diarrhea .
however the meta - analysis included only liraglutide and exenatide and did not provide specific data on asian patients . as with efficacy , there is limited data on the gi tolerability of glp-1ras in asian populations and even more so in korean patients .
the recent meta - analysis found that the rr of nausea ( 13.8 vs. 3.3 , p=0.100 ) and vomiting ( 21.0 vs. 5.2 , p=0.205 ) were numerically higher in asians than in non - asians but were not statistically significantly different .
conversely , the rr of diarrhea was numerically , but not statistically , higher in non - asians ( 1.7 vs. 2.6 , p=0.275 ) . in a korean retrospective cohort analysis of patients who used exenatide , 23/143 ( 16.1% ) had nausea and 17 ( 11.9% ) suffered from vomiting .
only eight patients stopped taking exenatide due to anorexia or vomiting , all had above target hba1c levels and were receiving two oral hypoglycemic agents but not insulin in the 3 months prior to study inclusion .
reported a similar safety profile with the use of exenatide in asians as in non - asian patients ; nausea , which was generally mild - to - moderate , as the most common adverse event with exenatide ( 25% vs. 1% with placebo ) .
a total of 64 subjects ( 7% ) withdrew from the study by yang et al .  
adverse gi events , predominantly diarrhea , nausea , and vomiting led to the majority of these withdrawals . amongst those gi adverse events most occurred within the first 4 weeks , were transient and decreased over time . in the harmony-7 study patients in the albiglutide group had more injection - site reactions and fewer gi adverse events than did those in the liraglutide group .
in the getgoal - l - asia study 61% of patients in the lixisenatide group reported having had a gi adverse event versus 14.6% in the placebo group ; nausea occurred most frequently ( 39.6% of patients ) , followed by vomiting ( 18.9% ) and diarrhea ( 6.5% ) .
in this exclusively asian population , the frequency of nausea was slightly higher than had been observed in global populations ( 39.6% vs. 22% to 25% ) .
potential explanations for the higher incidence of gi adverse events amongst asian patients include higher drug exposure due to the lower bmi of the participants ( vs. non - asian studies ) .
gi adverse events are generally transient ; they tend to be higher during the first 2 weeks of treatment and often decrease with ongoing use . nevertheless , when such events are experienced in the early stages of treatment they have the potential to impact patient compliance . to help with this
, patients should be informed of the potential for these effects , including their likely duration , before treatment commences .
fear of hypoglycemia is a major barrier to optimizing glycemic control in patients with t2 dm . hypoglycemic events increase the direct and indirect economic burden of diabetes and also have a negative impact on a patient 's quality of life and confidence in diabetes self - management ability . preventing hypoglycemic events and the early detection of patients at high risk for hypoglycemia are important aspects of clinical care . in the recent meta - analysis by kim et al .
, there was no significant difference in the rr of hypoglycemia with glp-1ras between asian and non - asian populations ( 2.8 vs. 1.5 , respectively ; p=0.164 ) . in the study by gao et al .  
the incidence of symptomatic hypoglycemia was higher in exenatide - treated patients than those who received placebo ( 36% and 9% , respectively ; p<0.001 ) .
hypoglycemia rates ( events / patient - year ) for patients taking exenatide with metformin alone were 1.8 and this increased to 4.7 amongst those taking metformin plus a sulfonylurea .
there were no reported incidences of hypoglycemia in the retrospective cohort analysis 52 korean patients after 6 months ' therapy with exenatide .
, only two subjects in the glimepiride group reported major hypoglycemia while there were none in the liraglutide groups . in the getgoal - l - asia study 42.9% of lixisenatide - treated patients and 23.6% of those receiving placebo reported symptomatic hypoglycemia ; none of these events was severe . when patients also receiving a sulfonylurea
were excluded the incidence of hypoglycemia in the lixisenatide group was comparable to that in the placebo group ( 32.6% vs. 28.3% ) .
the most frequently reported adverse events with glp-1ras are gi related and include nausea , vomiting , and diarrhea .
for example , a study of lixisenatide versus liraglutide found that the incidences of nausea ( 23% vs. 22% ) and vomiting ( 10% vs. 7% ) were similar in both groups , whereas diarrhea was more common in the liraglutide group ( 16% vs. 3% ) . a recent meta - analysis sought to interrogate the data from randomised controlled trials with glp-1ras ( liraglutide and exenatide ) and assess the impact of different doses on gi adverse events .
pairwise random - effects meta - analyses and mixed treatment comparisons found that , relative to placebo , exenatide 10 mg twice - daily is significantly more likely to cause nausea and vomiting whilst liraglutide 1.2 mg once a day is significantly more likely to cause diarrhea .
however the meta - analysis included only liraglutide and exenatide and did not provide specific data on asian patients . as with efficacy , there is limited data on the gi tolerability of glp-1ras in asian populations and even more so in korean patients .
the recent meta - analysis found that the rr of nausea ( 13.8 vs. 3.3 , p=0.100 ) and vomiting ( 21.0 vs. 5.2 , p=0.205 ) were numerically higher in asians than in non - asians but were not statistically significantly different .
conversely , the rr of diarrhea was numerically , but not statistically , higher in non - asians ( 1.7 vs. 2.6 , p=0.275 ) . in a korean retrospective cohort analysis of patients who used exenatide , 23/143 ( 16.1% )
only eight patients stopped taking exenatide due to anorexia or vomiting , all had above target hba1c levels and were receiving two oral hypoglycemic agents but not insulin in the 3 months prior to study inclusion .
reported a similar safety profile with the use of exenatide in asians as in non - asian patients ; nausea , which was generally mild - to - moderate , as the most common adverse event with exenatide ( 25% vs. 1% with placebo ) .
a total of 64 subjects ( 7% ) withdrew from the study by yang et al .  
adverse gi events , predominantly diarrhea , nausea , and vomiting led to the majority of these withdrawals . amongst those gi adverse events most occurred within the first 4 weeks , were transient and decreased over time . in the harmony-7 study patients in the albiglutide group had more injection - site reactions and fewer gi adverse events than did those in the liraglutide group . in the getgoal - l - asia study 61% of patients in the lixisenatide group
reported having had a gi adverse event versus 14.6% in the placebo group ; nausea occurred most frequently ( 39.6% of patients ) , followed by vomiting ( 18.9% ) and diarrhea ( 6.5% ) . in this exclusively asian population ,
the frequency of nausea was slightly higher than had been observed in global populations ( 39.6% vs. 22% to 25% ) .
potential explanations for the higher incidence of gi adverse events amongst asian patients include higher drug exposure due to the lower bmi of the participants ( vs. non - asian studies ) .
gi adverse events are generally transient ; they tend to be higher during the first 2 weeks of treatment and often decrease with ongoing use . nevertheless , when such events are experienced in the early stages of treatment they have the potential to impact patient compliance .
to help with this , patients should be informed of the potential for these effects , including their likely duration , before treatment commences .
the available data , in global and asian populations , support a number of benefits with the use of glp-1ras .
these include a reduction hba1c levels , weight maintenance or loss , and a relatively low risk of hypoglycemia .
these benefits are offset against the propensity for gi adverse effects early in the course of treatment and a lack of long - term outcomes data .
population statistics suggest that increasing age and obesity are key factors contributing to t2 dm in korea . in a cohort study involving 34,999 korean men and women aged 30 to 59 years who were free of diabetes at baseline , metabolic health status , obesity , and weight change
were all shown to be independently associated with increased incidence of t2 dm over 5 years of follow - up .
whilst the overall prevalence of diabetes in adults 30 years and older is 12.4% , it increases with age such that it affects 23.2% of koreans aged 60 to 69 years and 25.9% of those aged 70 years or more .
half of all koreans with t2 dm are obese ( when defined as a bmi 25.0 kg / m and a waist circumference > 90 cm in men and > 85 cm in women ) with data showing the highest prevalence of obesity ( 63.6% ) and abdominal obesity ( 57.6% ) amongst those aged 40 to 49 years . given these statistics , treatment approaches that contribute to weight management such as the glp-1ras are becoming more relevant in the current management of t2 dm in korea .
the inclusion of a prandial glp-1ra into the treatment regimen of overweight patients with high hba1c due to postprandial hyperglycemia is reasonable .
other clinical factors that may aid in treatment choice include uncontrolled hba1c due to high postprandial ( rather than fasting ) blood glucose levels , need to control weight particularly amongst patients who already have a basal insulin as part of their regimen , patients at increased risk of hypoglycemia and patients with or at high risk of cv comorbidities , such as hypertension and fatty liver .
the different pharmacodynamic features of glp-1ras may help guide the decision to administer a glp-1ra with basal insulin ; using short - acting lixisenatide or exenatide twice - daily in patients with prandial or postprandial hyperglycemia after near normalisation of fasting blood glucose and long - acting exenatide lar , liraglutide , albiglutide or dulaglutide if the main concern is elevated fasting blood glucose levels .
whilst korean - specific data are limited , much progress has been made in understanding the full scope of their utility in the management of t2 dm .
gaps in the literature that would warrant further research in the korean population include the impact of glp-1ra treatment on the recovery of insulin secretion , their effects on -cell function and insulin sensitivity , whether they modulate improvements in endothelial dysfunction , their impact on lipid metabolism and any associations between their glucose lowering efficacy and gi side effects .
in concluding , we ask the question how does the above data help inform the optimal management of t2 dm in korea ? the global data , in general , demonstrate that glp-1ras can contribute to patient management , providing beneficial reduction in hba1c , without weight gain or hypoglycemia .
more data are needed to examine efficacy , safety , and optimal dosing of glp-1ras in korean patients with t2 dm . however , based on the data currently available , their use is appropriate in several patient groups , including patients whose hba1c is uncontrolled , especially if this is due to postprandial glucose excursions and patients who are overweight or obese due to dietary problems ( e.g. , appetite control ) .
whether or not the potential for gi adverse events is increased in asian patients , the possibility that it might occur should be explained to patients at treatment initiation to help maintain patient compliance .
 glucagon - like peptide-1 receptor agonists ( glp-1ras ) reduce glycosylated hemoglobin ( hba1c , 0.5% to 1.0% ) , and are associated with moderate weight loss and a relatively low risk of hypoglycemia . 
 there are differences between asian and non - asian populations . 
 we reviewed available data on glp-1ras , focusing on korean patients , to better understand their risk / benefit profile and help inform local clinical practice . 
 control of postprandial hyperglycemia is important in asians in whom the prevalence of post - challenge hyperglycemia is higher ( vs. non - asians ) . 
 the weight lowering effects of glp-1ras are becoming more salient as the prevalence of overweight and obesity among korean patients increases . 
 the higher rate of gastrointestinal adverse events amongst asian patients in clinical trials may be caused by higher drug exposure due to the lower body mass index of the participants ( vs. non - asian studies ) . 
 data on the durability of weight loss , clinically important health outcomes , safety and optimal dosing in korean patients are lacking . 
 use of glp-1ras is appropriate in several patient groups , including patients whose hba1c is uncontrolled , especially if this is due to postprandial glucose excursions and patients who are overweight or obese due to dietary problems ( e.g. , appetite control ) . 
 the potential for gastrointestinal adverse events should be explained to patients at treatment initiation to facilitate the promotion of better compliance . 