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Management of type 2 diabetes mellitus: basal Insulin and glucagon-like peptide-1 receptor agonist combination treatment


Combination treatment with a glucagon-like peptide-1 ( GLP-1 ) agonist and basal Insulin has been proposed as a treatment strategy for type 2 diabetes mellitus that could provide robust glucose-lowering capability with low risk of hypoglycaemia or weight gain.
A systematic review and meta-analysis of randomised controlled trials was done to assess the effect of this combination treatment on glycaemic control, hypoglycaemia, and weight gain in patients with type 2 diabetes mellitus.

Researchers systematically searched for randomised controlled trials ( published between Jan 1, 1950, and July 29, 2014 ) comparing GLP-1 agonist and basal Insulin combination treatment to other anti-diabetic treatments.
The main endpoints were glycaemic control, hypoglycaemia, and change in weight.
Researchers assessed pooled data by use of a random-effects model.

Of 2905 identified studies, 15 were eligible and were included in our analysis ( n=4348 participants ).

Compared with other anti-diabetic treatments, GLP-1 agonist and basal Insulin combination treatment yielded an improved mean reduction in glycated haemoglobin ( HbA1c ) of −0.44% ( 95% CI −0.60 to −0.29 ), an improved likelihood of achieving the target HbA1c of 7.0% or lower ( relative risk [ RR ] 1.92; 95% CI 1.43 to 2.56 ), no increased relative risk of hypoglycaemia ( 0.99; 0.76 to 1.29 ), and a mean reduction in weight of −3.22 kg ( −4.90 to −1.54 ).

Furthermore, compared with basal-bolus insulin regimens, the combination treatment yielded a mean reduction in HbA1c of −0.1% ( −0.17 to −0.02 ), with lower relative risk of hypoglycaemia ( 0.67, 0.56 to 0.80 ), and reduction in mean weight ( −5.66 kg; −9.8 to −1.51 ).

GLP-1 agonist and basal Insulin combination treatment can enable achievement of the ideal trifecta in diabetic treatment: robust glycaemic control with no increased hypoglycaemia or weight gain.
This combination is thus a potential therapeutic strategy that could improve the management of patients with type 2 diabetes mellitus. ( Xagena )

Eng C et al, Lancet 2014; 384: 2228–2234

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