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GLP-1 receptor agonist with basal insulin viable option in type 2 diabetes
In patients with type 2 diabetes inadequately controlled with basal insulin therapy, the addition of a prandial GLP-1 receptor agonist can improve glycemic control and may improve body weight without added hypoglycemia risk, according to a review of clinical trials.
“Consider a prandial GLP-1 receptor agonist when glycemic targets are not met with basal insulin as an alternative to adding mealtime insulin,” Ronald M. Goldenberg, MD, FRCPC, FACE, an endocrinologist with LMC Thornhill and North York General Hospital in Toronto, told Endocrine Today. “This will offer excellent efficacy with less hypoglycemia and less weight gain than adding mealtime insulin. Fixed-ratio combinations allow for a simple, once-daily injection of a combination GLP-1 receptor agonist with basal insulin.”
Goldenberg and colleagues analyzed data from 10 clinical trials of basal insulin therapy with add-on prandial GLP-1 receptor agonists, including exenatide (Byetta, AstraZeneca), lixisenatide (Adlyxin, Sanofi) and a fixed-ratio treatment of insulin glargine and lixisenatide (Soliqua, Sanofi).
In all included studies, GLP-1 receptor agonist therapy as an add-on to basal insulin therapy was demonstrated to be safe and effective, with most studies demonstrating equal or slightly superior efficacy to the addition of prandial insulin, the researchers wrote. Patients in the trials also experienced weight loss and less hypoglycemia than those with add-on prandial insulin therapy.
In one study of lixisenatide in patients with type 2 diabetes and acute coronary syndrome, researchers found that the addition of lixisenatide to usual care did not alter the rate of major adverse cardiac events or other serious adverse events.
“Barriers against insulin use, such as fear of weight gain and hypoglycemia, exist, and gastrointestinal events, such as nausea and vomiting, lead to low adherence and frequent discontinuation of GLP-1 [receptor agonists],” the researchers wrote. “The combination of a prandial GLP-1 [receptor agonist] with a basal insulin analogue in a single-injectable preparation may provide synergistic effects.”
The researchers noted that the fixed-ratio combination of insulin glargine and lixisenatide may aid in patient adherence and improve glycemic control while mitigating the risk of weight gain in patients with poorly controlled type 2 diabetes on basal insulin therapy. – by Regina Schaffer
For more information:
Ronald M. Goldenberg MD, FRCPC, FACE, can be reached at LMC Thornhill, 531 Atkinson Ave. #17, Thornhill, ON L4J 8L7, Canada; email: ronaldgoldenberg@gmail.com.
Disclosures: Sanofi Canada funded this study. Goldenberg reports he receives speaking fees, research fees and consultant fees from AstraZeneca, Eli Lilly, Novo Nordisk and Sanofi. Please see the study for the other author’s relevant financial disclosures.