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With agents like semaglutide and tirzepatide becoming household drug names, Peterson discusses the short-term future of incretin drug development.

Kevin Peterson, MD, MPH: Incretin Therapy's Potential 

Editorial Advisory Board was surveyed on the question, “In 10 years, what will we remember as the biggest story in medicine from 2023?”

Surprising few, the board primarily voted for the progression of GLP-1 receptor agonists—from promising metabolic agents to revolutionary treatments in obesity management.

 Over the span of the last 5 years, indications for GLP-1 receptor agonists including semaglutide (Ozempic) have progressed from type 2 diabetes, to cardiovascular event risk reduction, to renal outcomes and now, to clinical weight reduction.

 In the same time, agents have advanced to late-stage trials for the potential treatment of renal, hepatic and gastric outcomes.

Incretin therapies are, to paraphrase the advisory board, the biggest story in medicine. And that doesn’t appear to be changing anytime soon.

American Academy of Physician Associates (AAPA) 2024 Conference & Expo

 in Houston, TX, this week, Kevin Peterson, MD, MPH, professor in the department of family medicine and community health at the University of Minnesota and vice president of the American Diabetes Association (ADA), discussed his expert outlook on the much-celebrated drug class.

“The incretins are going to, I think, change the whole paradigm of the way we treat diabetes,” Peterson said. “We've really began to redefine weight management and obesity as a separate medical problem, and the incretins give us one of the first capabilities of addressing that effectively.”

Peterson noted the drug class has the potential to change the scale of concern placed on obesity and weight management strategies—especially given the proven clinical efficacy in reducing risk of comorbid cardiovascular events or metabolic diseases.

“ I think that's one of the impacts of the incretins is that it addresses obesity, and so it has a multifactorial set of diseases that it treats: cardiovascular disease, diabetes, even depression,” Peterson said. “I think it'll redefine our paradigm of treatment of weight in the primary care setting.“

While semaglutide and other incretin therapies are being largely celebrated for their weight management benefit, more novel clinical pursuits with the drug class are being considered. 

 has recently covered considerations to treat psychiatric conditions including depression and addiction,

 as well as hematologic and even gastric outcomes.

Peterson said this expansion of clinical research with the drug class may be due to the mechanism of action: GLP-1 receptor agonists target both the gut and brain, he explained.

“It delays gastric emptying, it reduces gluconeogenesis following meals from the liver, or at least excretion of glucose from the liver,” Peterson said. “Most people would say that the weight loss is predominantly an effect in your brain, but it certainly slows gastric emptying, it increases satiety. It kind of provides that ileal break that may not exist so much in people.”

As a third generation of the GLP-1 receptor agonist drug class—nearing 30 unique investigative agents—is currently in development, Peterson prospects that the effect of the drug class will only be amplified by its strategic pairing with hormonal agents.

“Depending on how you mix and match some of these gastrointestinal hormones, they have substantial and complementary effect,” he said. “So, it's going to be an interesting next few years. I don't know where it's going to stop, but it's I think that it's it's very effective and it's going to become more effective.”

Kunzmann K. The 6 Biggest Stories in Medicine in 2023. 

. Published December 1, 2023. https://www.hcplive.com/view/6-biggest-stories-medicine-2023

Campbell P. Semaglutide: The Drug of Today and a Steppingstone to Tomorrow. 

. Published December 6, 2023. https://www.hcplive.com/view/semaglutide-drug-today-steppingstone-tomorrow

Kunzmann K. Roger S. McIntyre, MD: GLP-1 Agonists for Psychiatry? 

. Published May 5, 2024. https://www.hcplive.com/view/roger-mcintyre-md-glp-1-agonists-for-psychiatry

Iapoce C. SGLT2 Inhibitor Use Lowers Anemia Risk in Patients with Diabetes, CKD. 

. Published March 5, 2024. https://www.hcplive.com/view/sglt2-inhibitor-use-lowers-anemia-risk-patients-diabetes-ckd

Iapoce C. SGLT2is, GLP-1s Display Reno-Protective Benefit in Sickle Cell Disease. 

. Published April 28, 2024. https://www.hcplive.com/view/sglt2is-glp-1s-display-reno-protective-benefit-sickle-cell-disease

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Kevin Peterson, MD, MPH: Incretin Therapy's Potential

The matters of long-term PCOS management may heavily depend on what stage of life the patient is in—and how the disease itself has presented.

Danielle O'Laughlin, PA-C, MS: Navigating Long-Term Risks, Family Planning in PCOS

Polycystic ovary syndrome (PCOS) carries a high prevalence among women—estimated at approximately 1 in 10 and increasing over time.

 But an exacerbation of that high prevalence rate for clinicians who manage patients with PCOS is the multitude of ways by which it can impact them long-term—and how it may alter lifestyle decisions and behaviors.

 in Houston, TX, this week, Danielle O’Laughlin, PA-C, MS, a physician associate in Mayo Clinic’s division of community internal medicine, geriatrics and palliative care, discussed her session presentation on PCOS management in the primary care setting.

O’Laughlin discussed the matter of navigating treatment in a patient with PCOS who may be interested in bearing children. As she explained, the issue may be as heterogenous as the condition itself—but the sentiment of treatment is fairly consistent.

“A lot of times, our treatment and our education is focused on, 'Okay, let's reduce your risk factors’,” O’Laughlin said. “You need to have regular menstrual periods so that you can ovulate on a regular basis, so you can get pregnant. So to do that, we want to make sure that you don't have impaired fasting glucose or diabetes, we want to make sure we're preventing all the things that we can.”

Weight loss in patients who are overweight may help restore menstrual regulation, O’Laughlin said; diet and exercise are common recommendations for PCOS, as may be metformin.

Another recourse may be recommending birth control to affected patients prior to their attempts to get pregnant, O’Laughlin said.

“And then sometimes we have to jump to ovulation induction—whether we're using medications or we're referring for that, but there's lots of options,” O’Laughlin said. “It just depends on how long have they been trying to get pregnant, when do they want to get pregnant and where they're at on that spectrum.”

O’Laughlin additionally discussed the matter of long-term outcome risks in patients with PCOS, which can range from metabolic disease like diabetes, hormonal effects like early menopause onset or endometrial cancer,

“I will say that if in today's life phase, you don't want to be on birth control, that's fine. We can do the things to get you pregnant and that sort of thing,” she said. “But long term, we need to have some plan to protect the endometrium. That might be birth control…that's going to reduce the risk of endometrial hyperplasia and then reduce their risk of endometrial cancer.”

From the risk of metabolic diseases, behavior modification in exercise, sleep and diet are primary topics. But regarding psychological effects, the matter may be diverse: O’Laughlin said anxiety, depression, eating disorders and psychosexual dysfunction are more common in women with PCOS.

“This is a disease process that has different risks at different parts of your life,” O’Laughlin said. “And we can do a lot to prevent that and monitor those (risks). They need to know education for the pre-family planning, the family planning stage, or the post-family planning stage, depending on where they're at.”

Deswal R, Narwal V, Dang A, Pundir CS. The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. 

. 2020;13(4):261-271. doi:10.4103/jhrs.JHRS_95_18

Johnson NP. Metformin use in women with polycystic ovary syndrome. 

. 2014;2(6):56. doi:10.3978/j.issn.2305-5839.2014.04.15

Kunzmann K. PCOS status linked to menopause age onset. 

 Published March 28, 2024. https://www.contemporaryobgyn.net/view/pcos-status-linked-to-menopause-age-onset

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The Critical Role of RAASi Therapy in Chronic Kidney Disease, with Wei Ling Lau, MD

Consistency in medication adherence is crucial for maximizing the benefits of renin–angiotensin–aldosterone system inhibitors (RAASi) medications, particularly in reducing heart failure events, hospitalizations, stroke mortality, and maintaining blood pressure control and urine protein levels over the long term. Interrupting therapy intermittently, such as needing to pause treatment due to high potassium levels and then restarting it, can disrupt desired outcomes. However, with the availability of strategies to address potassium issues, patients can feel more confident about staying on their medications without encountering complications.

,Wei Ling Lau, MD, interim chief in the Division of Nephrology, Hypertension & Kidney Transplantation at the University of California, Irvine, discusses her session on enabling optimal RAASi therapy, presented at the 

National Kidney Foundation (NKF) 2024 Spring Clinical Meeting

Numerous studies, she noted, have extensively documented the significant cardiovascular benefits of RAASi therapy in chronic kidney disease. Interrupting RAASi therapy, whether due to high potassium levels, side effects, or other reasons, has been associated with increased risks of heart failure and premature mortality. Consequently, healthcare providers should aim to maintain patients on RAASi therapy consistently to optimize their cardiovascular health outcomes. Historically, concerns about RAASi therapy contributing to a decline in kidney function have led to hesitancy in continuing treatment, with fears of worsening kidney disease. However, recent evidence, including findings from the STOP-ACEi clinical trial, has debunked this notion, demonstrating that discontinuing RAASi therapy does not affect the rate of kidney function decline over time.

Maintaining a balanced approach is essential, particularly regarding dietary potassium intake. While it is important to avoid excessive consumption of high-potassium foods, such as fruits and vegetables, these items are integral to a healthy lifestyle and overall well-being. According to Lau, the importance of a balanced diet and adherence to RAASi therapy is crucial for patient health. Additionally, incorporating newer oral potassium binders into chronic management strategies can help mitigate potassium-related concerns, allowing for a more heart-healthy diet while continuing essential medications for heart and kidney health.

Disclosures: Lau has no relevant disclosures to report.

Wei Ling Lau, MD, explains the importance of medication adherence to maximize the benefits of RAASi therapy. 

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Mitigating Hyperkalemia While Maintaining Optimal RAASi Therapy, with Wei Ling Lau, MD

Renin–angiotensin–aldosterone system inhibitors (RAASi) medications have long been established as the standard of care for reducing cardiovascular events and mortality in various patient groups, including those with chronic kidney disease, diabetes, heart failure, and hypertension. However, the primary challenge associated with these medications has always been the risk of hyperkalemia, a condition characterized by elevated blood potassium levels, which can lead to severe arrhythmias and sudden cardiac arrest. This potential side effect has significantly limited the optimization of RAASi therapy due to safety concerns.

, Wei Ling Lau, MD, interim chief in the Division of Nephrology, Hypertension & Kidney Transplantation at the University of California, Irvine, discusses her session on enabling optimal RAASi therapy, presented at the 

RAASi medications encompass several subgroups, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and mineralocorticoid receptor antagonists (MRAs). Both ACE inhibitors and ARBs are considered excellent choices, with no compelling evidence favoring one over the other. However, Lau noted patients may switch between these agents if they experience side effects such as a dry cough. MRAs, such as spironolactone and the newer agent finerenone, are particularly beneficial for patients with diabetes who have persistent proteinuria.

Mitigating hyperkalemia while maintaining optimal RAASi therapy poses a significant clinical challenge. Traditionally, dietary restrictions targeting high-potassium foods like bananas, avocados, and potatoes have been recommended. However, implementing such restrictions can be challenging, as many of these foods are essential components of a heart-healthy diet rich in fruits and vegetables. Additionally, restricting potassium-rich foods may inadvertently lead to decreased fiber intake, exacerbating issues like constipation, particularly in the kidney disease population.

Alternative strategies for managing hyperkalemia include the use of diuretics to increase urinary potassium excretion and sodium-glucose cotransporter-2 (SGLT2) inhibitors, which have shown potential in lowering blood potassium levels.

Historically, dialysis patients have been managed with lower potassium concentrations during dialysis sessions, but this approach has fallen out of favor due to associated mortality risks. The introduction of newer oral potassium binders, such as patiromer and sodium zirconium cyclosilicate, has revolutionized hyperkalemia management, allowing for long-term potassium control while enabling patients to maintain optimal RAASi therapy and dietary flexibility.

Wei Ling Lau, MD, explains how to enable optimal RAASi therapy while reducing hyperkalemia risk. 

Updates to the AHA’s Cardiovascular Disease Risk Calculator, with Michael Shlipak, MD, MPH

The risk factors for cardiovascular disease, such as diabetes, smoking, dyslipidemia, and high blood pressure, have long been recognized. However, a recent development is the acknowledgment of chronic kidney disease as a significant risk factor for cardiovascular issues. This recognition is reflected in the new cardiovascular risk equation from the American Heart Association, which now incorporates kidney function and damage through albuminuria into its components.

,Michael Shlipak, MD, MPH, associate chief of medicine for research at the San Francisco VA Medical Center and a professor of medicine at the University of California, San Francisco School of Medicine, discusses his 

 presentation on the updated American Heart Association’s cardiovascular disease risk calculator.

While family history is widely acknowledged as a risk factor for cardiovascular disease, modern genetic studies have enabled the development of genetic risk scores. These scores contribute to understanding cardiovascular risk, although they do not account for a significant portion of it. His session highlighted the importance of the new cardiovascular risk equation, particularly in primary care settings, where physicians utilize cardiovascular risk assessment tools to determine appropriate preventive therapies for patients, such as statins or aspirin.

The updated risk equation offers several advantages over its predecessor, including a larger population size and broader diversity in age and ethnicity. Notably, it excludes race and instead utilizes a social deprivation index to capture environmental factors. Additionally, the incorporation of kidney function measures, such as estimated glomerular filtration rate (eGFR) and albuminuria, as well as heart failure as an outcome, enhances its predictive accuracy and relevance, especially for individuals with kidney disease.

Shlipak explains although the new risk calculator represents a significant advancement, there are considerations to address, such as individuals with extreme family history of cardiovascular disease and the need for further validation in different geographic settings. Moreover, he emphasizes the importance of routine kidney testing, particularly urine albumin tests, in primary care settings is crucial for early detection and management of kidney disease and for predicting cardiovascular risk accurately.

Disclosures: Shlipak has participated in advisory boards for Beyer, Boehringer Ingelheim, and AstraZeneca. He receives research funding from Beyer.

Michael Shlipak, MD, MPH, explains updates to the American Heart Association's cardiovascular risk equation, which now incorporates kidney function and damage through albuminuria into its components. 

 and joined the MJH Life Sciences team in April 2021. He graduated from The College of New Jersey with a degree in Journalism and Professional Writing. He enjoys listening to records, going to concerts, and playing with his cat Squish. You can reach him at 

The smartphone app demonstrated higher accuracy, sensitivity, and specificity in patients with severe anemia than those with moderate anemia.

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Smartphone App Accurate in Anemia Detection from Conjunctival Images 

Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

This analysis may help bring to light more specific skin cancer-related data on the underserved population of non-Hispanic Black, or NHB, patients.


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Patients with IgAN receiving iptacopan achieved a 38.3% reduction in proteinuria at month 9. 

Iptacopan Treatment Significantly Reduces Proteinuria in IgAN

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HCV testing was accepted by more than 80% of patients undergoing mammography and resulted in prompt linkage to care.

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Focusing on the evolving treatment paradigms for HIV, the panel reviews guideline recommendations for initial therapy and discusses education practices for newly diagnosed patients.

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Check out this quiz on the NKF's KDOQI recommendations on nutrition in chronic kidney disease, with a focus on their guidance for protein and energy intake!

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Clinical Quiz: Protein and Energy Intake in Chronic Kidney Disease from KDOQI Guidelines

Findings demonstrated a slower decline in kidney function for patients treated with sparsentan or irbesartan compared with standard of care in both real-world and clinical trial settings.


Latest News

Kevin Peterson, MD, MPH: Incretin Therapy's Potential

Danielle O'Laughlin, PA-C, MS: Navigating Long-Term Risks, Family Planning in PCOS

The Critical Role of RAASi Therapy in Chronic Kidney Disease, with Wei Ling Lau, MD

Mitigating Hyperkalemia While Maintaining Optimal RAASi Therapy, with Wei Ling Lau, MD

Updates to the AHA’s Cardiovascular Disease Risk Calculator, with Michael Shlipak, MD, MPH