GLP-1 Agonist, Basal Insulin Powerful Against T2DM

Combination treatment of type 2 diabetes with a GLP-1 agonist and basal insulin resulted in significant improvements in glycemic control without a resulting increase in weight or other adverse events, according to the results of a meta-analysis looking at 15 studies of the drug combination.

“These data thus lend support to GLP-1 agonist and basal insulin combination treatment as a therapeutic strategy that can improve the management of type 2 diabetes,” study author Conrad Eng, MSc, of Mount Sinai Hospital, Toronto, and colleagues wrote in The Lancet.

According to the study, there is increasing interest in the combination use of GLP-1 agonists and basal insulin for the treatment of type 2 diabetes, particularly because of its potential for robust glucose-lowering.

To examine existing data on combination use of these two drugs, Eng and colleagues conducted a systematic review of all randomized controlled studies done between 1950 and July 2014 comparing combination treatment with a GLP-1 agonist and basal insulin to other anti-diabetes treatments.

Their search yielded 15 eligible clinical studies that included 4,348 patients. Results from these studies showed that combination treatment resulted in a significant 44% reduction in HbA1c levels (95% CI, –0.60 to –0.29), which was greater than any other treatment strategy.

Fourteen of the 15 studies looked at the proportion of patients who achieved an HbA1c of 7% or less. When patients were treated with the combination of a GLP-1 agonist and basal insulin they had an improved likelihood of achieving an HbA1c of 7% or less (RR=1.92; 95% CI, 1.43-2.56) than they did with other treatment strategies.

“In the sensitivity analysis, GLP-1 agonist and basal insulin combination treatment was associated with a lower risk of low blood sugar than was basal-bolus insulin treatment, with no significant between-study heterogeneity,” the researchers wrote.

Similarly, combination treatment led to a mean reduction in weight that was greater than that seen with other diabetes treatments.

“These findings show the comparative beneficial effects of GLP-1 agonists versus bolus insulin, and suggest that GLP-1 agonists should be considered when intensifying treatment in patients on basal insulin,” the researchers wrote. “Most importantly, these data are supportive of an important improvement in the management of type 2 diabetes.”

References:

Eng C, Kramer CK, Zinman B, Retnakaran R. Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis. Lancet. 2014;384:2228-2234