GLP-1 Agonists: Revolution in Cardiology – From Diabetes Medication to Cardiometabolic All-Rounder

Semaglutide, Tirzepatide, and Co. conquer new indications: From diabetic nephropathy to sleep apnea to heart failure. What doctors in Austria need to know about the cardioprotective effects in 2025.

Reading time: 12 minutes | Target audience: Cardiologists, Internists, Diabetologists, General Practitioners

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A medication, many effects: The paradigm shift

When I first heard about GLP-1 receptor agonists in intensive care three years ago, these substances were primarily known as diabetes medications. Today, in 2025, we are witnessing an unprecedented expansion of indications: Cardiovascular protection, renal protection, sleep apnea therapy – and this is just the beginning.

The history of GLP-1 agonists shows how a targeted molecular approach can lead to unexpected therapeutic benefits. What was developed as a means to lower blood sugar levels turns out to be a master of pleiotropy with organ-protective properties that extend far beyond metabolism.

The current situation in Austria and Germany

Prevalence of relevant diseases:

• Type 2 diabetes: approx. 800,000 Austrians, 8.5 million Germans
• Obesity (BMI ≥30): 20% in Austria, 24% in Germany
• Heart failure: 250,000 Austrians, 4 million Germans
• Chronic kidney disease: 800,000 Austrians (Stage 3-5)
• Obstructive sleep apnea: 5-10% of adults, often undiagnosed

The overlap of these diseases is enormous: A patient with type 2 diabetes has a 2-4 times increased risk of heart failure and chronic kidney disease. This is exactly where GLP-1 agonists come into play.

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Biochemistry and mechanism of action: More than blood sugar reduction

What are GLP-1 agonists?

GLP-1 (Glucagon-like Peptide-1) is a natural gut hormone (incretin) released from L-cells of the small intestine after food intake. Physiological effects:

1. Pancreas: Glucose-dependent insulin secretion ↑, glucagon secretion ↓
2. Stomach: Delayed gastric emptying
3. Brain: Appetite reduction, feeling of satiety
4. Heart: Direct cardioprotective effects (!)
5. Kidney: Glomerular protection
6. Liver: Reduction of steatosis

Problem: Native GLP-1 has a half-life of only 2-3 minutes (enzymatic degradation by DPP-4).

Solution: Synthetic GLP-1 receptor agonists with extended half-life:

• Liraglutide (Victoza®, Saxenda®): Half-life ~13 hours, daily
• Semaglutide (Ozempic®, Wegovy®, Rybelsus®): Half-life ~7 days, weekly
• Dulaglutide (Trulicity®): Half-life ~5 days, weekly

The game changer: Dual and triple agonists

Tirzepatide (Mounjaro®, Zepbound®): Dual GIP/GLP-1 receptor agonist

• Acts on two incretin receptors
• GIP (Glucose-dependent Insulinotropic Peptide) enhances metabolic effects
• Stronger weight reduction than pure GLP-1 agonists
• FDA approval for diabetes: 2022, obesity: 2023, sleep apnea: December 2024

Retatrutide (in development): Triple agonist

• GLP-1 + GIP + glucagon receptor
• Phase 2 studies: Weight reduction up to 24% after 48 weeks
• Market launch possibly 2026-2027

Cardiovascular mechanisms: Why do GLP-1 agonists protect the heart?

The cardioprotective effects go far beyond blood sugar and weight reduction:

1. Direct myocardial effects:

• GLP-1 receptors demonstrated in myocardium
• Improvement of left ventricular function
• Reduction of oxidative stress
• Anti-apoptotic effect on cardiomyocytes

2. Vascular effects:

• Endothelial NO synthesis ↑ → Vasodilation
• Reduction of inflammation (CRP ↓, IL-6 ↓)
• Improvement of arterial stiffness
• Anti-atherogenic effects (LDL oxidation ↓)

3. Hemodynamic effects:

• Blood pressure reduction (-3 to -5 mmHg systolic)
• Natriuresis (volume reduction)
• Reduction of afterload

4. Metabolic effects:

• Weight reduction → reduced cardiac load
• Improvement of insulin sensitivity
• Lipid profile improvement (triglycerides ↓)

5. Anti-inflammatory systemic effect:

• Reduction of systemic inflammation
• Adipokine modulation
• Improvement of endothelial function

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The new indications in 2025: An overview

1. Diabetic nephropathy: FDA approval for Semaglutide (January 2025)

Historic milestone: On January 28, 2025, the FDA expanded the approval of Semaglutide (Ozempic®) to reduce the risk of:

• Progression of kidney disease
• Kidney failure (end-stage renal disease)
• Death from cardiovascular causes

in adults with type 2 diabetes and chronic kidney disease (CKD).

The FLOW study as an evidence base:

The randomized, placebo-controlled FLOW study (Flavour of Life with Ozempic®) examined 3,533 patients with:

• Type 2 diabetes
• CKD Stage 2-4
• eGFR 25-75 ml/min/1.73m²
• Albumin-creatinine ratio ≥300 mg/g

Primary endpoint (composite):

• Persistent ≥50% eGFR reduction
• End-stage renal disease (dialysis/transplantation)
• Kidney-related deaths
• Cardiovascular deaths

Results after a median of 3.4 years:

• 24% risk reduction of the primary endpoint (HR 0.76; 95% CI 0.66-0.88)
• 20% reduction in proteinuria
• Slowing of eGFR decline
• Additionally: 18% reduction in cardiovascular events

Significance for practice: This is the first GLP-1-specific kidney indication. Until now, SGLT2 inhibitors (Dapagliflozin, Empagliflozin) were the only substances with nephroprotective evidence in diabetes.

Combination with SGLT2 inhibitors: In FLOW, 69% of patients received SGLT2 inhibitors in parallel – the additive effect suggests synergistic protection.

Availability in Austria:

• Ozempic® is reimbursed for type 2 diabetes with inadequate control
• Nephroprotective indication not yet explicitly in the reimbursement code
• Off-label use for kidney indication legally possible, cost coverage on a case-by-case basis

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2. Obstructive sleep apnea: Tirzepatide as first-in-class (December 2024)

Paradigm shift: On December 20, 2024, the FDA approved Tirzepatide (Zepbound®) for the treatment of moderate to severe obstructive sleep apnea (OSA) in adults with obesity.

This is the first medication for OSA therapy ever.

The SURMOUNT-OSA study:

Two identically designed phase 3 studies with a total of 469 patients:

• OSA severity: AHI ≥15 events/hour
• Obesity: BMI ≥30 kg/m²
• Two cohorts: With/without CPAP therapy

Primary endpoint: Change in the Apnea-Hypopnea Index (AHI)

Results after 52 weeks:

Cohort without CPAP:

• Tirzepatide: AHI reduction of 25-30 events/hour
• Placebo: AHI reduction of 5 events/hour
• Difference: -20 to -25 events/hour (p<0.001)

Cohort with CPAP:

• Tirzepatide in addition to CPAP: AHI reduction of 27 events/hour
• Placebo + CPAP: AHI reduction of 4 events/hour
• Synergistic effect

Weight reduction: -18% of body weight (vs. -1.2% placebo)

Pathophysiology explains the effect:

• OSA in obesity: Collapse of the upper airways due to fat deposits (tongue, pharynx)
• Weight reduction → less soft tissue mass → improved airway
• Additionally: GLP-1-mediated reduction of systemic inflammation

Practical implications:

• Alternative for CPAP-intolerant patients (30-50% discontinue CPAP)
• Treatment of the cause (obesity), not just the symptom
• However: Not a substitute for CPAP in severe OSA without weight reduction response

Availability in Austria:

• Mounjaro® (Tirzepatide) approved for diabetes
• Zepbound® (obesity indication) not yet available in the EU (approval expected)
• OSA indication not yet approved in Europe

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3. Heart failure with preserved ejection fraction (HFpEF)

New evidence 2025: Recently published real-world data from Germany show:

Study by Dr. Nils Krüger (TU Munich/German Heart Foundation):

• Database analysis of patients with HFpEF and type 2 diabetes
• Comparison: Semaglutide/Tirzepatide vs. no GLP-1 therapy
• Result: Over 40% reduction in the risk of:
  • Heart failure-related hospitalization
  • Cardiovascular death

Published in JAMA, August 2025 (PMID: 40886075)

The STEP-HFpEF studies (Semaglutide):

• HFpEF + obesity (BMI ≥30)
• Primary endpoint: KCCQ (Kansas City Cardiomyopathy Questionnaire)
• Result: Significant improvement in quality of life and 6-minute walk distance

Mechanism in HFpEF:

• Weight reduction → reduced preload
• Improvement of diastolic function
• Reduction of systemic inflammation
• Improvement of endothelial function
• Favorable effects on hypertension

Difference to HFrEF: In heart failure with reduced EF (HFrEF), the data situation is still unclear. Caution in advanced HFrEF (NYHA III-IV) due to weight loss and sarcopenia risk.

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4. Cardiovascular primary and secondary prevention

The major cardiovascular outcome studies (CVOTs):

SUSTAIN-6 (Semaglutide):

• 3,297 patients, type 2 diabetes, high CV risk
• Median follow-up: 2.1 years
• Result: 26% reduction in MACE (Major Adverse Cardiovascular Events)
  • Non-fatal myocardial infarction: -26%
  • Non-fatal stroke: -39%
  • Cardiovascular death: -0.98 (n.s.)

SELECT study (Semaglutide in obesity WITHOUT diabetes):

• 17,604 patients with:
  • Obesity or overweight
  • Established cardiovascular disease
  • WITHOUT type 2 diabetes (!)
• Primary endpoint: MACE (CV death, myocardial infarction, stroke)

Results (August 2023, NEJM):

• 20% reduction in MACE (HR 0.80; 95% CI 0.72-0.90)
• Effect independent of weight reduction
• Evidence: Cardioprotective effect extends beyond metabolism

Significance: SELECT was groundbreaking because it showed that GLP-1 agonists also protect cardiovascular health in non-diabetics. This led to the FDA approval of Wegovy® for cardiovascular risk reduction.

SURMOUNT-MMO (Tirzepatide) – ongoing:

• 15,000 patients with obesity without diabetes
• Cardiovascular endpoints as primary goal
• Results expected: 2027
• Could show: Tirzepatide > Semaglutide in CV protection?

Nature Medicine study (November 2025):

• Real-world data from Germany
• Semaglutide vs. Sitagliptin (DPP-4 inhibitor)
  • 18% reduction in stroke/myocardial infarction
• Tirzepatide vs. Dulaglutide (older GLP-1)
  • 13% reduction in MACE + death
• Important: Effect sets in early (< 6 months) → not just due to weight loss

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Practical application: Which patient benefits?

Indication based on patient profile

Profile 1: Type 2 diabetes + cardiovascular risk

Characteristics:

• HbA1c >7.0% despite metformin
• Cardiovascular disease (CAD, history of MI, stroke)
• Or: High CV risk (SCORE2 >10%)

Treatment choice:

• Semaglutide (Ozempic®) once a week or
• Tirzepatide (Mounjaro®) once a week or
• Dulaglutide (Trulicity®) once a week

Advantage: Reimbursement in Austria for diabetes

Profile 2: Type 2 diabetes + chronic kidney disease

Characteristics:

• eGFR 25-75 ml/min/1.73m²
• Albuminuria (ACR ≥30 mg/g)
• Progression risk

Treatment choice:

• Semaglutide (Ozempic®) – FLOW evidence
• Combination with SGLT2 inhibitor (additive effect!)

Monitoring:

• eGFR every 3-6 months
• Albuminuria control
• Initial eGFR dip (10-15%) is physiological

Profile 3: Obesity + obstructive sleep apnea

Characteristics:

• BMI ≥30 kg/m²
• AHI ≥15 events/hour (polysomnography)
• CPAP intolerant or rejecting

Treatment choice:

• Tirzepatide (as soon as OSA indication is available in the EU)
• Currently: Off-label with obesity justification possible

Monitoring:

• Polysomnography after 6-12 months
• Epworth Sleepiness Scale
• Weight trend

Profile 4: Heart failure HFpEF + obesity

Characteristics:

• LVEF ≥50%
• NT-proBNP elevated
• Symptoms (NYHA II-III)
• BMI ≥30 kg/m²

Treatment choice:

• Semaglutide (Wegovy®) 2.4 mg/week – STEP-HFpEF evidence
• Cave: No reimbursement in Austria!

Monitoring:

• NT-proBNP trend
• Echocardiography every 6-12 months
• 6-minute walk test
• Quality of life (KCCQ)

Profile 5: Prediabetes + metabolic syndrome

Characteristics:

• HbA1c 5.7-6.4%
• Abdominal obesity
• Hypertension, dyslipidemia
• High progression risk to diabetes

Treatment choice:

• Off-label: Low-dose semaglutide
• Primary: Lifestyle intervention
• GLP-1 as an adjunct in case of lack of success

Evidence: No approval yet, but studies show diabetes prevention by 60-80%

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Dosing and titration: The key to success

Semaglutide (Ozempic®, Wegovy®)

Starting dose: 0.25 mg s.c. once a week (induction phase)

Titration (every 4 weeks):

• Week 1-4: 0.25 mg
• Week 5-8: 0.5 mg
• Week 9-12: 1.0 mg (diabetes)
• Week 13+: 2.4 mg (obesity, CV protection)

Maintenance dose:

• Diabetes: 1.0 mg (max. 2.0 mg)
• Obesity/CV: 2.4 mg

Injection technique: Subcutaneous, abdominal/thigh/upper arm, constant weekday

Tirzepatide (Mounjaro®, Zepbound®)

Starting dose: 2.5 mg s.c. once a week

Titration (every 4 weeks):

• Week 1-4: 2.5 mg
• Week 5-8: 5 mg
• Week 9-12: 10 mg
• Week 13+: 15 mg (option if needed)

Maintenance dose:

• Diabetes: 5-15 mg (individual)
• Obesity: 10-15 mg

Special feature: Higher effectiveness than semaglutide, but also more GI side effects

Oral option: Semaglutide (Rybelsus®)

Special feature: First oral GLP-1 preparation

Dosing:

• Start: 3 mg/day for 30 days
• Then: 7 mg/day (or 14 mg if needed)

Intake:

• On an empty stomach, in the morning
• With max. 120 ml of water
• Wait 30 minutes before food/other medications

Advantage: No injection (compliance in case of needle phobia)

Disadvantage: Complicated intake, lower effectiveness than subcutaneous

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Side effects: What patients need to know

Gastrointestinal side effects (most common!)

Prevalence:

• Nausea: 20-50% (dose-dependent)
• Vomiting: 10-20%
• Diarrhea: 15-30%
• Constipation: 10-20%
• Abdominal pain: 10-15%

Management:

1. Slow titration (do not skip!)
2. Small, frequent meals
3. Low-fat diet initially
4. Sufficient fluids
5. For persistent nausea: Antiemetics (Metoclopramide, Ondansetron)
6. If intolerable: Dose reduction or pause

Caveat: GI side effects usually decrease after 8-12 weeks (tolerance development)

Risk of pancreatitis: Overestimated?

Post-marketing surveillance:

• Incidence: ~0.1-0.2% (slightly increased vs. background risk)
• Mostly in at-risk patients (cholecystolithiasis, hypertriglyceridemia)

Watch for symptoms:

• Severe abdominal pain, belt-like
• Nausea, vomiting
• Lipase ↑↑↑

Management: In case of suspected pancreatitis → immediately discontinue GLP-1, clinically evaluate

Hypoglycemia risk

Monotherapy: Very low (glucose-dependent insulin secretion!)

Combination with:

• Insulin: Hypoglycemia risk ↑↑ → reduce insulin dose (approx. -20%)
• Sulfonylureas: Hypoglycemia risk ↑ → reduce/discontinue SU
• Metformin, SGLT2i, DPP4i: No relevant hypo-risk

Patient education: BZ self-monitoring in combination therapy!

Thyroid C-cell tumors: Theoretical risk

Animal data: Increased risk in rodents (not in primates)

Contraindication:

• Medullary thyroid carcinoma (MTC) in personal history
• Multiple endocrine neoplasia type 2 (MEN2) familial

Practice: Very rare contraindication, no screening calcitonin required

Gallbladder diseases

Cholecystolithiasis, cholecystitis:

• Risk slightly increased (1-2%)
• Mechanism: Rapid weight loss → supersaturated bile

Prevention: Discuss ursodeoxycholic acid in at-risk patients

Progression of diabetic retinopathy

SUSTAIN-6 subanalysis:

• Slightly increased risk in pre-existing proliferative retinopathy
• Mechanism: Rapid HbA1c reduction → microcirculation dysregulation

Practice:

• Ophthalmological control before starting in known retinopathy
• Slow HbA1c reduction in advanced retinopathy

Weight loss-associated risks

Sarcopenia risk:

• Muscle mass loss: ~20-30% of weight loss
• Prevention: High-protein diet (1.2-1.5 g/kg), strength training!

"Ozempic Face" (media-hyped):

• Facial fat loss → sunken face
• Cosmetic issue, no medical relevance
• More common in older patients

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Contraindications and precautions

Absolute contraindications

• Medullary thyroid carcinoma (personal/family)
• MEN2 syndrome
• Severe hypersensitivity reaction to GLP-1-RA
• Pregnancy and breastfeeding

Relative contraindications/precautions

• Acute pancreatitis in history (weigh risks)
• Severe renal insufficiency (eGFR <15) – data limited
• Severe heart failure NYHA IV – caution with further weight loss
• Diabetic gastroparesis – may be exacerbated
• Desire for pregnancy – discontinue 2 months before conception

Dosage adjustment in renal insufficiency

Important: No dosage adjustment required for CKD!

• Also approved with eGFR <30 ml/min (FLOW study!)
• Caveat: GI side effects may be more frequent in CKD

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Interactions: What to consider?

Delayed gastric emptying → oral medications affected

Affected:

• Levothyroxine: Possibly 4h interval to GLP-1 injection
• Antibiotics: Consider in acute therapies
• Oral contraceptives: Effect levels may decrease (additional contraception initially?)
• Warfarin: INR monitoring more frequent

Not affected:

• Metformin, SGLT2i, statins (no clinically relevant interactions)

Combination with other antidiabetics

Meaningful combinations:

• Metformin + GLP-1: Standard, synergistic
• SGLT2i + GLP-1: Complementary mechanisms, very effective
• Basal insulin + GLP-1: Insulin savings, less hypo

Problematic combinations:

• DPP-4 inhibitors + GLP-1: Do not combine (redundant mechanism)
• Sulfonylureas + GLP-1: Hypo-risk, better to discontinue SU

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Costs and reimbursement: The economic reality

Prices in Austria (as of January 2025)

Semaglutide (Ozempic®):

• 0.25/0.5 mg (4 doses): ~120 euros
• 1.0 mg (4 doses): ~135 euros
• Annual costs diabetes: ~1,620-1,800 euros

Semaglutide (Wegovy®) – obesity:

• 2.4 mg (4 doses): ~280-300 euros
• Annual costs: ~3,600 euros
• No reimbursement in Austria!

Tirzepatide (Mounjaro®):

• 2.5/5 mg (4 doses): ~180 euros
• 10/15 mg (4 doses): ~270 euros
• Annual costs: ~2,700-3,500 euros

Tirzepatide (Zepbound®) – obesity:

• Not yet available in the EU
• USA: ~1,000 $/month = ~12,000 $/year

Reimbursement by Austrian health insurance

GLP-1 agonists for type 2 diabetes: ✅ Reimbursable (reimbursement code) if:

• HbA1c ≥7.0% despite metformin monotherapy
• Or metformin intolerance
• BMI ≥30 kg/m² (or ≥27 kg/m² with comorbidities)

Chief or approval physician: Usually not required for diabetes indication

GLP-1 agonists for obesity WITHOUT diabetes: ❌ No reimbursement (lifestyle medication)

• Self-payer: 3,600 euros/year
• Private supplementary insurance: In individual cases (usually not)

Off-label applications (OSA, HFpEF): ❌ No standardized reimbursement

• Individual applications to health insurance possible
• Usually rejected, except for well-documented medical necessity

Germany: Similar situation

GKV reimbursement:

• Type 2 diabetes: ✅ Yes
• Obesity: ❌ No (SGB V § 34 – lifestyle exclusion)

PKV: Partial coverage for medical indication

Supply shortages: The current problem

Status January 2025:

• Semaglutide (Ozempic®, Wegovy®): Temporary supply shortages in Austria/Germany
• Tirzepatide (Mounjaro®): Improved availability
• Cause: Massive off-label demand for weight reduction

Novo Nordisk and Eli Lilly have massively expanded production capacities, but demand continues to exceed supply.

Consequence for patients:

• Start of therapy sometimes delayed
• Pharmacy rotation required
• Import goods from EU abroad

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Future: What comes next?

Oral GLP-1 agonists of the second generation

Orforglipron (Eli Lilly – in Phase 3):

• Oral, once daily
• Non-peptidic → better oral bioavailability
• Weight reduction: ~15% after 36 weeks
• Approval possibly in 2026

Triple agonists: Retatrutide & Co.

Retatrutide (Eli Lilly – Phase 2 completed):

• GLP-1 + GIP + glucagon receptor
• Weight reduction: 24% after 48 weeks (!)
• Superiority vs. Tirzepatide/Semaglutide?
• Phase 3 studies ongoing

CagriSema (Novo Nordisk):

• Combination: Semaglutide + Cagrilintide (amylin analog)
• Synergistic weight reduction
• Phase 3 studies ongoing

Long-acting formulations

Monthly injections: Several candidates in development

• Improved compliance
• Fewer injections → higher acceptance

Cardiovascular combinations

Incretins + SGLT2i: Fixed combination in development

• Synergistic CV and renal protection
• Simplified therapy (one injection)

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Controversies and ethical questions

1. Lifestyle medication vs. chronic disease

Obesity is a disease, not a lifestyle problem:

• WHO recognized since 1997
• Chronic, multifactorial disease
• Association with >200 comorbidities

But: Social stigmatization leads to "lifestyle" classification

• Consequence: No reimbursement
• Two-tier medicine: The rich can afford therapy

2. Off-label use for cosmetic weight reduction

Problem:

• Celebrities use Ozempic® for desired weight
• TikTok/Instagram hype
• Consequence: Supply shortages for diabetics

Medical responsibility:

• Strict indication setting
• Education about side effects
• No prescriptions for normal-weight individuals

3. Lifelong therapy required?

Reality: After discontinuation, weight gain of 2/3 of lost weight within 1 year

Implications:

• Chronic therapy like antihypertensives?
• Costs over decades?
• Long-term safety (>10 years) still unclear

Alternative: Therapy pause after weight stabilization + lifestyle intervention?

4. Global justice

Problem:

• Medications unaffordable in low-income countries
• Obesity pandemic a global problem
• Unequal access opportunities

Hope: Generics after patent expiration (Liraglutide already generic, Semaglutide in 2026)

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Practical recommendations for doctors in Austria

When to start GLP-1 agonist?

Type 2 diabetes:

• HbA1c ≥7.0% despite metformin (≥3 months)
• Or earlier in case of high CV risk
• Never wait for multi-tablet failure!

Obesity:

• BMI ≥30 kg/m² (or ≥27 with comorbidities)
• After 6 months of documented lifestyle intervention without success
• Discuss realistic expectations (15-20% weight loss possible)

Cardiovascular indication:

• Established CV disease + diabetes → GLP-1 early
• HFpEF + obesity → consider off-label (cost clarification!)

Which GLP-1 agonist for which patient?

Prefer semaglutide for:

• Established CV disease (SELECT evidence)
• Chronic kidney disease (FLOW evidence)
• Cost-sensitive patient (reimbursement for diabetes)

Prefer tirzepatide for:

• Primary goal: Weight reduction (more potent)
• HbA1c very high (>9%)
• Obesity + sleep apnea (as soon as approved)

Prefer dulaglutide for:

• Cost optimization in diabetes
• Easier injection (pre-filled pen)

Liraglutide (daily):

• Today mostly no longer first choice (weekly options better)
• Option in case of intolerance to long-acting GLP-1

Interdisciplinary collaboration

Diabetologist/Internist:

• Therapy initiation
• Titration, monitoring

Cardiologist:

• CV risk stratification
• Combination with cardiological therapy
• HFpEF management

Nephrologist:

• CKD patients
• Combination SGLT2i + GLP-1
• Progression monitoring

Nutrition counseling:

• Essential for long-term success!
• Protein supplementation (sarcopenia prevention)
• Behavior modification

Monitoring parameters

Baseline:

• HbA1c, fasting glucose
• Lipid profile (LDL, HDL, TG)
• Creatinine, eGFR, albumin-creatinine ratio
• Liver values (AST, ALT, GGT)
• TSH (if thyroid history)
• Weight, BMI, waist circumference

Follow-up:

• Month 1: Tolerability, side effect recording, weight
• Month 3: HbA1c, weight, lipids, kidney function
• Month 6: Like month 3
• Thereafter: HbA1c every 6 months, lipids annually

In CKD additionally:

• eGFR every 3 months
• ACR every 3-6 months

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Patient education: What do I say?

Communicate realistic expectations

"GLP-1 agonists are very effective medications, but not miracle cures."

What GLP-1 can do:

• Lower blood sugar (HbA1c -1.5 to -2%)
• Reduce weight (10-20% over 1 year)
• Protect heart and kidneys
• Slightly lower blood pressure

What GLP-1 cannot do:

• Cure diabetes (chronic disease)
• Maintain weight loss without lifestyle change
• Completely avoid side effects

Emphasize the importance of lifestyle

"The medication supports you, but the foundation is your lifestyle."

Nutrition:

• High in protein (preserving muscle mass)
• High in fiber (GI tolerance)
• Small, frequent meals (reduce nausea)

Exercise:

• Strength training 2-3x/week (sarcopenia prophylaxis!)
• Aerobic training 150 min/week
• Increase daily activity

Behavior change:

• Reflect on eating patterns
• Address emotional eating
• Develop long-term strategies

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Your partner for diabetes and cardiology needs: MeinArztbedarf

The modern GLP-1 therapy requires structured monitoring and professional diagnostics. At MeinArztbedarf.at, doctors and medical facilities in Austria can find:

Diagnostic equipment for GLP-1 therapy

Blood glucose measurement & HbA1c analytics:

• Point-of-care HbA1c systems for practices
• Continuous glucose monitoring systems (CGM) – Freestyle Libre, Dexcom
• Quality-tested blood glucose meters

Cardiovascular diagnostics:

• ECG devices (resting and stress ECG)
• 24-hour blood pressure monitors
• Pulse oximetry and capnography

Kidney diagnostics:

• Urine analysis systems
• Albumin-creatinine ratio rapid tests
• Laboratory centrifuges for practice labs

Weight management tools:

• Medical body composition scales (bioimpedance)
• Anthropometry sets (waist measurement tapes, calipers)
• Nutrition counseling materials

Training and injection materials

• Insulin and GLP-1 injection training sets
• Patient education materials for diabetes
• Cool boxes for GLP-1 pens (travel)

Practice equipment for diabetology/cardiology

• Examination tables and chairs
• Medical documentation systems
• Emergency equipment (AED, emergency kits)

Consultation for your practice: Our physician-led team (Dr. Daniel Pehböck, emergency and intensive care medicine) provides individual advice on equipping your diabetological or cardiological practice.

📧 Contact: info@meinarztbedarf.at
📞 Phone: +43 (0) 5223 / [Your Number]
🌐 Online shop: www.meinarztbedarf.at

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Conclusion: GLP-1 agonists as a cardiometabolic therapeutic principle

GLP-1 receptor agonists have rapidly evolved from niche antidiabetics to multi-indication therapeutics. The evidence for cardiovascular, renal, and now also pulmonary (OSA) protection is overwhelming.

The key take-home messages:

1. GLP-1 agonists protect the heart and kidneys independent of glucose and weight reduction
2. Early use in high-risk patients (CV disease, CKD) is crucial
3. Tirzepatide shows higher effectiveness than semaglutide, but long-term CV data are still pending
4. New indications (nephropathy, sleep apnea, HFpEF) massively expand the therapeutic spectrum
5. Costs and availability remain hurdles – political solutions required
6. Lifelong therapy likely required → long-term safety to be monitored

Outlook for 2025 and beyond

The GLP-1 story is far from over:

• Orally available preparations improve compliance
• Triple agonists could further enhance effectiveness
• Primary prevention in high-risk obesity possible?
• Cardiovascular combination preparations with SGLT2i

As doctors, we must actively shape these developments and ensure that innovative therapies benefit all patients – not just those who can afford them.

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Author: Dr. Daniel Pehböck, physician
Expertise: Emergency and intensive care medicine, University Hospital Innsbruck
Company: MeinArztbedarf GmbH, Hall in Tirol, Austria

Disclaimer: This article serves for medical education and does not replace individual medical advice. Therapy decisions must always be individualized. All information without guarantee. Status: January 2025.

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Meta-Description (160 characters):
GLP-1 agonists 2025: Semaglutide and Tirzepatide protect heart, kidney, and more. New indications, studies, and practice tips for doctors in Austria.

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Regional Keywords (GEO-SEO): Diabetology Innsbruck, Cardiology Tyrol, Obesity Center Vienna, Diabetes Clinic Austria, Endocrinology Salzburg, General Practitioner Hall in Tyrol, Internist Graz