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GLP-1RAs exert glycemic control through multiple mechanisms, including the stimulation of insulin secretion under hyperglycemic conditions, suppression of glucagon secretion during hyperglycemia, deceleration of gastric emptying to mitigate postprandial glucose spikes, reduction of caloric intake, and promotion of weight loss.71,8183 Short-acting GLP-1RAs, such as exenatide and lixisenatide, primarily reduce nocturnal and fasting glucose levels, while maintaining their effect on gastric emptying over prolonged treatment periods

Current data supports long-term use, but the WHO notes that more research is needed to understand effects beyond 23 years

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doi: 10.1093/hmg/8.12.2247

Chung WH, Hung SI