The 'incretin effect' exploited by GLP-1 receptor agonists means their insulinotropic effect is:

• A Maximal at fasting glucose levels and independent of blood glucose concentration
• B Glucose-dependent, occurring only when blood glucose is above the fasting threshold ✓
• C Mediated through inhibition of glucagon secretion at all blood glucose levels
• D Produced by direct inhibition of islet alpha-cells via somatostatin release

Explanation

GLP-1 receptor agonists stimulate insulin secretion only when plasma glucose is elevated above fasting levels (glucose-dependent insulinotropism), making hypoglycaemia very unlikely as monotherapy. When blood glucose approaches normal fasting levels, GLP-1 mediated insulin secretion diminishes. This contrasts with sulfonylureas, which promote insulin release independently of glucose concentration and therefore carry hypoglycaemia risk.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

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