Basal Insulin Shows Key Role in Diabetes Treatment

The results of a recently released study have once again shown the impact gut microbes can have on the health of patients with diabetes.

Researchers determined that a combination of basal insulin and a drug that serves the same role as a gut hormone would be a more effective treatment for patients than other non-diabetic options.

The results showed similar rates of hypoglycemia and greater weight loss as part of the systematic review and meta-analysis which was published in The Lancet.

“Achieving normal blood sugar levels in people with type 2 diabetes is compromised by the adverse side effects plaguing currently available treatments,” noted Ravi Retnakaran, MD, the study’s lead author and an endocrinologist at Mount Sinai Hospital in Toronto. “Some anti-diabetic treatments increase risk of hypoglycaemia and weight gain which puts patients at increased risk of heart attack or stroke, as well as reducing their quality of life.”

Researchers focused on glucagon-like peptide-1 (GLP-1), which is a hormone the body secretes from the gut after eating. It has also been used recently in treatment for patients with type 2 diabetes “because of its ability to regulate blood sugar levels and to generate weight loss as opposed to weight gain,” the statement noted. GLP-1 agonists have also been shown to “only stimulate insulin

secretion when blood glucose levels are high, without increasing risk of hypoglycaemia.”

The team identified 2,905 studies that compared GLP-1 agonist and basal insulin combination treatments to other anti-diabetic treatments. Using data from the 15 randomized trials that met their criteria (covering more than 4,300 participants), the authors noted by combining the two treatments patients had a 92% greater likelihood of reaching target blood sugar levels.

That included rates of hypoglycemia and an average weight loss of more than 3 kg when compared to other treatments. Comparing that data to other studies involving only full basal-bolus insulin, the authors found that treatment produced “modestly better blood sugar control,” but also a 33% lower risk of hypoglycemia and nearly 6 kg more weight loss.

“Combining a GLP-1 agonist with basal insulin is a treatment strategy that can achieve the ideal triumvirate of short-term outcomes in diabetes management: optimal glucose control alongside weight loss and a low risk of hypoglycaemic episodes,” Retnakaran said. “As such, this combination could improve the management of people with type 2 diabetes.”

In a linked comment, John Buse, MD, Chief of the Division of Endocrinology at the University of North Carolina School of Medicine said, “Perhaps the most practical and immediate issue is whether the fixed-dose combinations of a GLP-1 agonist and basal insulin in development will supersede other approaches.” He added, “This is an unsettled question, but it seems likely that fixed-dose

combinations will be welcomed in view of their convenience and efficacy.”

While the results showed promise, Buse said there were other factors that needed further examination, including the cost associated with the selected treatment options. “One can hope that some incremental cost savings will come with combined products. It has been a 20-year journey, but the combination of GLP-1 agonist and basal insulin has finally arrived as a more powerful and saver alternative to insulin in the management of type 2 diabetes,” he said.