Public interest in and uptake of glucagon-like peptide 1 (GLP-1)-based therapies—GLP-1 receptor agonists like semaglutide and liraglutide and dual-acting GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists like tirzepatide—have increased in recent years, and more incretin therapies are anticipated to enter the diabetes/obesity therapeutic space.

Prescription alone, however, is not sufficient for patients to achieve their therapeutic goals.

The Saturday, June 22, symposium Optimizing Outcomes of GLP-1+/GIP Receptor Agonists—How to Help Patients Succeed focused on how dietitians and certified diabetes care and education specialists (CDCES) can help patients obtain optimal benefits from GLP-1-based therapies.

The session can be viewed on-demand by registered meeting participants on the virtual meeting platform. If you haven’t registered for the 84^th Scientific Sessions, register today to access the valuable meeting content through Aug. 26.

“We certainly know that these medications are effective,” said Maureen Chomko, RD, CDCES, Neighborcare Health. “We know that there’s astonishing A1C measurements after people start these medications, and we also know that we have this fantastic side effect of body weight reduction.”

In addition, these agents improve cardiometabolic and renal measures. However, one of the challenges with using GLP-1- and GIP-based therapies is patient access to these medications due to shortages of health care providers who can prescribe them.

Ms. Chomko reviewed discontinuation rates in clinical studies and real-world analyses, another factor that can limit clinical benefit from incretin therapies. She noted that patients with diabetes are more non-persistent on these medications than those without.

“Unfortunately, we’re spending a lot of money on these medications, but we’re not realizing the potential benefits,” she said.

In this context, a competent and well-trained CDCES—a level 3 educator, according to the Association of Diabetes Care & Education Specialists (ADCES), trained to adjust treatment regimens—can ease the load on the clinical care team by implementing a standing order protocol for medication management.

Guidelines from the American Diabetes Association® (ADA) and other medical associations call for a collaborative multidisciplinary approach to care, and integrating a CDCES standing order protocol is one way to achieve that. A successful program that incorporates such protocol should include input from multiple stakeholders, bidirectional trust and communication between the CDCES and the clinical care team, and processes for building and adapting standing orders, Ms. Chomko said.

Still, there are care gaps.

“We see this often where a GLP-1 or GIP therapy is prescribed,” said Colleen Dawkins, FNP-C, RDN, CSOWM, Big Sky Medical Wellness. “There is no support for the patient.”

She said that adoption of an approach for incretin therapies that is similar to what is used for metabolic surgery can improve outcomes. This includes screening for disordered eating, pre-existing gastrointestinal disorders, and mental health concerns; focusing on sustainable lifestyle changes and quality of nutrition; side effect management planning; and education on proper medication use and storage.

Ms. Chomko also emphasized the importance of setting realistic expectations for the patient and educating them on the need for long-term treatment with incretin therapies.

Good nutrition, physical activity, adequate sleep, managing effects of other concurrent medications, and mental health can help patients stay on these medications and optimize their clinical benefits, she said. For instance, as patients on incretin therapies often tolerate a lower variety of foods, they need may need to add B12, iron, calcium, and/or other supplements.

Patients on incretin therapies also may benefit from muscle mass-preserving physical activity, as muscle loss concomitant with overall weight loss may be a concern.

Ms. Chomko noted the importance of tailoring support strategies for each patient and of focusing on “non-scale victories”—on improvement in quality of life—rather than on weight alone.

“Diabetes and obesity are chronic conditions,” she said. “The person that you’re talking to should be aware that these conditions are long-term concerns and that they will probably need long-term support.”