GLP1-RA Add-on Therapy in Patients with Type 2 Diabetes Currently on a Bolus Containing Insulin Regimen
| Autor: | Scott R. Drab, David Q. Pham, Marie L. Davies |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Blood Glucose
medicine.medical_specialty medicine.medical_treatment 030209 endocrinology & metabolism Type 2 diabetes Hypoglycemia Gastroenterology Glucagon-Like Peptide-1 Receptor 03 medical and health sciences 0302 clinical medicine Bolus (medicine) Diabetes mellitus Internal medicine Weight Loss medicine Humans Hypoglycemic Agents Insulin Pharmacology (medical) 030212 general & internal medicine Randomized Controlled Trials as Topic Glycated Hemoglobin Liraglutide business.industry medicine.disease Endocrinology Diabetes Mellitus Type 2 Dulaglutide business Exenatide medicine.drug |
| Zdroj: | Pharmacotherapy. 36(8) |
| ISSN: | 1875-9114 |
| Popis: | Adding glucagon-like peptide-1 receptor agonists (GLP-1 RAs) to basal insulin regimens has become a guideline-recommended treatment option for uncontrolled type 2 diabetes. However, limited data exist to support the use of GLP-1 RAs with insulin regimens, including bolus insulin in patients with type 2 diabetes. The primary objectives of this review were to identify if the combination of a GLP-1 RA and an insulin regimen containing bolus insulin resulted in improvements in HbA1c , weight loss, reduction in insulin doses, and to evaluate the side effect profile of this combination in terms of nausea and hypoglycemia risk. Eight studies using exenatide twice/day, liraglutide, and dulaglutide were reviewed ranging in average duration of follow-up from 3 to 15 months. Seven studies showed that addition of a GLP-1 RA was associated with significant HbA1c reductions ranging from 0.4% to 1.64% from baseline to follow-up. Patients in all eight studies had significant weight loss in the GLP-1 RA arm from baseline to follow-up ranging from 0.87 to 10.2 kg. In all the studies, total daily bolus insulin doses decreased 25-67% from baseline to follow-up. In some studies, a portion of patients were able to discontinue bolus insulin all together after initiation of a GLP-1 RA. In addition, in two randomized trials included in the review, the GLP-1 RA arm showed significant improvement in HbA1c and weight compared with the control group who received basal/bolus regimens. Nausea was identified in 7-42% of participants using GLP-1 RAs with insulin. Data support the use of GLP-1 RAs added to insulin regimens already containing bolus insulin for glycemic control, weight loss, and reduction or discontinuation of bolus insulin. |
| Databáze: | OpenAIRE |
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