Wednesday , November 22 2017
Home / Conditions / Type 2 Diabetes / Type 2 Diabetes Control with GLP-1 Agonist and Basal Insulin Combination

Type 2 Diabetes Control with GLP-1 Agonist and Basal Insulin Combination

Glucose regulation and weight management are very important factors when treating type 2 diabetes patients…

Prior studies have shown that glucagon-like peptide receptor agonist are beneficial not only for better glucose control but also helpful in weight reduction in patients with type 2 diabetes. Other studies and recommendations on type 2 diabetes patients with less response to oral anti-diabetic regimens usually lead to the use of basal insulin.

In this study, a systematic review and meta-analysis of randomized controlled trials are reviewed to assess the effect of GLP-1 agonist and basal insulin combination treatment in type 2 diabetes patients. The study also assessed glycemic control, hypoglycemia, and weight gain in patients with type 2 diabetes that were treated with the combination treatment.

See more GLP-1 Agonist Resources

Retrospectively selected trials were published between Jan 1, 1950, and July 29, 2014 (N=4348 participants). Fifteen of the trials were selected comparing GLP-1 agonist and basal insulin combination treatment to other anti-diabetic treatments between 2011 to 2014.

The combination treatment of GLP-1 agonist and basal insulin yielded an improved mean reduction in HbA1c of –0.44% (95% CI –0.60 to –0.29). An improved probability of reaching the target HbA1c of ≤ 7% (relative risk [RR] 1.92; 95% CI 1.43 to 2.56). There was no increased relative risk of hypoglycemia (0.99; 0.76 to 1.29), and a mean reduction in weight of –3.22 kg (-4.90 to -1.54).

This study shows the benefits and efficacy of using GLP-1 agonist in combination with basal insulin in type 2 diabetes patients. Although we can see that there was no risk of hypoglycemia or weight gain from the combined treatment, we still need to better educate our patients who are afraid of needles about the benefits these medications can produce. No documentation of any lifestyle modification such as diet and exercise were mentioned in this study which could bias some results.

Practice Pearls:

  • Addition of GLP-1 agonist to basal insulin regimen could help counter balance any possible weight gain from insulin alone
  • Lifestyle modifications should still be part of the combination of GLP-1 agonist with basal insulin in type 2 diabetes patients
  • This combination treatment may not be as effective in type 2 diabetics with decreased β-cell function — therefore more studies are needed

Conrad Eng, Caroline K Kramer, Bernard Zinman, et al. “Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis.” The Lancet (Vol384) December20/27,2014. Web. 4 Feb. 2015.