GLP-1 Receptor Agonist/Insulin Combinations

Robert A. Gabbay, MD, PhD: Two new combination drugs have been approved, and what they do is they combine a basal insulin, either glargine or degludec, with a GLP-1 (glucagon-like peptide-1) agonist.

GLP-1 agonists have a lot of advantages in terms of weight loss and in terms of cardiovascular risk reduction. Many patients that are on basal insulin, after a while, are not able to get good glucose control because they lack the ability to make sufficient insulin with meals. The use of a GLP-1 agonist provides a solution in that it stimulates insulin secretion that is meal-related, and, therefore, gives that added need for meal-time insulin.

There are 2 options, in a sense. One could go in that direction adding a GLP-1 agonist, or adding meal-time insulin, with a 3-times-a-day injection. The advantage of these combinations is that through a single injection, one gets a once-a-day dosing of basal insulin plus GLP-1 agonists, in a titratable manner. And that, I think, is an attractive approach for a lot of patients. It makes things simpler for them. They can adjust their doses on an every-few-days’ basis, based on their blood sugar control, and not need to immediately go to basal bolus, which in essence would be 4 injections a day. One injection versus 4 injections—many patients prefer 1 injection.

Transcript edited for clarity.