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Basal insulin plus GLP-1 improves HbA1c in type 2 diabetes
Adults with type 2 diabetes inadequately treated with basal insulin who add a GLP-1receptor agonist experience greater changes in HbA1c compared with those who add a rapid-acting insulin or increase their basal insulin dose, according to a study.
Philip Levin, MD, of Model Clinical Research in Towson, Maryland, and colleagues evaluated data from the MarketScan database on 8,034 adults with type 2 diabetes not adequately controlled using basal insulin alone who underwent treatment intensification within 6 months of showing poor glycemic control to determine the clinical and economic outcomes associated with the addition of a GLP-1 receptor agonist or rapid-acting insulin or an increase in basal insulin dose. Outcomes were evaluated 12 months after treatment intensification.
Basal insulin dose was adjusted in 4,131 participants, 2,076 received rapid-acting insulin and 331 received GLP-1 receptor agonists.
At follow-up, changes in HbA1c levels were similar for the GLP-1 receptor agonist and rapid-acting insulin cohorts but higher with GLP-1 receptor agonists compared with the dose-adjustment group (P < .001). The GLP-1 receptor agonist group experienced fewer hypoglycemic events compared with the rapid-acting insulin group (P = .012) and the dose-adjustment group (P = .007). No significant differences were found between the different intensification groups for rates of severe hypoglycemia. Among participants who never experienced a hypoglycemia episode 6 months before intensification, fewer hypoglycemic events were reported by participants who received GLP-1 receptor agonists compared with the other intensification strategies. The frequency of coronary artery disease was lower in the GLP-1 receptor agonist group compared with the dose-adjustment group (P = .0496), whereas there was no difference between the GLP-1 receptor agonist and rapid-acting insulin groups.
No significant differences were found between the treatment groups for total all-cause annual health care costs.
According to the researchers, basal insulin treatment intensification may “be a reasonable option in regard to clinical outcomes and economic burden, with additional hypoglycemia-reducing effects and potential cardioprotection benefits.” – by Amber Cox
Disclosures: Levin reports various financial ties with Amylin Pharmaceuticals, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly and Company, Janssen Pharmaceuticals, Merck & Co., Novo Nordisk, Roche and Sanofi. Please see the study for all other authors’ relevant financial disclosures.