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In clinical trials where a GLP-1 RA was added to background basal insulin, a general 20% basal insulin reduction in all patients or a 20% reduction in patients with an A1C 8.0%, the GLP-1 RA can be reasonably initiated without a reduction in the basal insulin dose for many patients

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GLP-1 class trials typically exclude people with: a recent major cardiovascular event (within 90 days in most protocols), personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia type 2 (MEN2), current use of GLP-1 receptor agonists or other weight-loss medications, severe kidney or liver disease, recent bariatric surgery, or active pregnancy