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Best Glycemic Control for T2DM Attained with GLP-1 Agonist + Insulin

Using a GLP-1 agonist with insulin may be the most effective therapy combination for lowering HbA1c in type 2 diabetes patients….

Researchers performed a systematic review and pooled meta-analysis of randomized controlled trials published between January 1, 1950 and July 29, 2014.

Out of the 2,905 studies that were identified, 15 were considered eligible to be included in the analysis. The researchers reviewed and analyzed a total of 4,348 participants. Glycemic control, hypoglycemia, and change in weight were the main endpoints of this analysis. The pooled data was assessed using a random-effects model.

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Results indicated that, in comparison to other antidiabetic treatments, treatment with a GLP-1 agonist and basal insulin combination resulted in an improved mean reduction in HbA1c of −0.44% (95% CI −0.60 to −0.29, p <0.0001), a higher likelihood of achieving the target HbA1c of ≤ 7% (relative risk [RR] 1.92; 95% CI 1.43 to 2.56, p <0.0001), no increased relative risk of hypoglycemia (RR 0.99; 95% CI 0.76 to 1.29), and a mean weight reduction of −3.22 kg (95% CI −4.90 to −1.54, p <0.0001). In addition, when compared to basal-bolus insulin regimens, the combination treatment produced a mean reduction in HbA1c of −0.1% (95% CI −0.17 to −0.02) with a decreased relative risk of hypoglycemia (RR 0.67, 95% CI 0.56 to 0.80) and a mean weight reduction of −5.66 kg (95% CI −9.8 to −1.51, p <0.0001).

Out of the multitudes of available treatment methods for type 2 diabetes, combination treatment with a GLP-1 agonist and basal insulin proved to be ideal. For patients with type 2 diabetes, this combination was superior at glucose-lowering against other antidiabetic treatments with no increase in the risk of hypoglycemia and significantly greater weight loss, making it the best strategy to improve the management of type 2 diabetes. On the downside, however, these two agents are very expensive.

Practice Pearls:

  • In type 2 diabetes, combination treatment with a GLP-1 agonist and basal insulin produced greater mean reductions in HbA1c (−0.44%) and weight loss (−3.22 kg) with no increase in hypoglycemia risk compared to other antidiabetic treatments.
  • This combination was also superior to basal-bolus insulin regimens in terms of mean reduction in HbA1c (−0.1%) and weight loss (−5.66 kg) with a lower hypoglycemia risk.
  • Although the two agents in combination make the ideal choice in managing type 2 diabetes, they are both very expensive.

The Lancet, http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61335-0/abstract