( GLP-1 RAs recently appearing on the market, in particular liraglutide, semaglutide and tirzepatide (a GIP/GLP-1 RA dual agonist) seek to overcome the problem of the short plasma half-life of native GLP-1 through (i) changing the amino acid sequence of the peptide so that it is no longer broken down by DPP-4, and/or (ii) attaching a long acyl chain to the peptide, thus allowing it to bind to albumin, and avoid rapid elimination via the kidney
If you do have diabetes and are on insulin or sulfonylureas along with the GLP-1, then you need to monitor blood sugars closely, as those other meds might need dose reductions to avoid hypos
Acta 1830 (5), 32893303
Semaglutide remains appropriate for most patients across kidney function ranges, though monitoring becomes important with moderate to severe renal impairment
But theyre not risk-free, and were still learning about long-term effects
They work differently, so "better" depends on what you're trying to address