Exenatide Twice Daily Plus Glargine Versus Aspart 70/30 Twice Daily in Patients With Type 2 Diabetes With Inadequate Glycemic Control on Premixed Human Insulin and Metformin

Chen, Xi; Xu, Yongping; Zhang, Jianhua; Shao, Shiying; Duan, Yanran; Liu, Peiwen; Li-ya, Shen; Zhang, Jing; Zeng, Jing; Shi, Zhengyi; Ma, Jianhua; Zhao, Tong; Hu, Juping; Liao, Yong; Chen, Xiaowen; Hu, Shufang; Xue, Yan; Zeng, Zhaoyang; Wang, He; Liu, Zhelong; Li, W.; Liu, Liegang; Yin, Ping; Yu, Xuefeng

doi:10.1016/j.eprac.2021.03.015

“…[18,24] Our study concept is also similar to recently published studies, except that they used iGlaLixi fixed combination therapy. [25,26] Similar to our results, body weight, HbA1c, and therapeutic total insulin dose can be adjusted by changing the therapeutic strategy improved by GLP-1RA plus basal insulin; and also did not increase the risk of hypoglycemia.…”

Section: Discussionsupporting

confidence: 87%

The efficacy and safety of combined GLP-1RA and basal insulin therapy among inadequately controlled T2D with premixed insulin therapy

Liu

¹

,

Su

²

,

Kuo

³

et al. 2023

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This study investigated the effect of a combination of glucagon-like peptide-1 receptor agonist (GLP-1 RA) and basal insulin (BI) in poorly controlled type 2 diabetes mellitus previously treated with premixed insulin. The possible therapeutic benefit of the subject is mainly hoped to provide a direction for optimizing treatment options to reduce the risk of hypoglycemia and weight gain. A single-arm, open-label study was conducted. The antidiabetic regimen was switched to GLP-1 RA plus BI to replace previous treatment with premixed insulin in type 2 diabetes mellitus subjects. After 3 months of treatment modification, GLP-1 RA plus BI was compared for superior outcomes by continuous glucose monitoring system. There were 34 subjects at the beginning, 4 withdrew due to gastrointestinal discomfort, and finally 30 subjects completed the trial, of which 43% were male; the average age was 58 ± 9 years old, and the average duration of diabetes was 12 ± 6 years, the baseline glycated hemoglobin level was 8.6 ± 0.9 %. The initial insulin dose of premixed insulin was 61 ± 18 units, and the final insulin dose of GLP-1 RA + BI was 32 ± 12 units (P < .001). Time out of range (from 59%-42%), time-in-range (from 39%-56%) as well as glucose variability index including standard deviation also improved, mean magnitude of glycemic excursions, mean daily difference and continuous population in continuous glucose monitoring system, continuous overall net glycemic action (CONGA). Also noted was a decrease in body weight (from 70.9 kg-68.6 kg) and body mass index (all P values < .05). It provided important information for physicians to decide to modify therapeutic strategy as individualized needs.Abbreviations: BI = basal insulin, BMI = body mass index, CGMS = continuous glucose monitor system, CPNGA = continuous overall net glycemic action, GLP-1 RA = glucagon-like peptide-1 receptor agonist, GV = glucose variability, HbA1C = glycated hemoglobin, LDL-C = low-density lipoprotein cholesterol, MAGE = mean amplitude of glycemic excursions, MODD = mean of daily differences, SD = standard deviation, T2D = type 2 diabetes mellitus, TBR = time-below-range.

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“…Premixed insulin therapy is the most commonly used treatment method in China. Patients can choose to use premixed insulin alone for treatment, or they can choose premixed insulin combined with oral hypoglycemic drugs such as metformin entericcoated tablets or acarbose for treatment [6]. Clinically relevant studies have shown that the above treatment methods can effectively control patients' blood glucose, but there are relatively few clinical reports on their all-weather blood glucose fluctuations, overall efficacy, and treatment costs [7].…”

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Clinical Effects of Insulin Aspart Combined with Acarbose and Metformin in the Treatment of Diabetes Mellitus

Jin¹,

Zhang²

2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To investigate the clinical effect of Insulin aspart 30 combined with acarbose and metformin enteric-coated tablets in the treatment of diabetes mellitus. Methods. 90 diabetic patients admitted to our hospital from January 2019 to December 2021 were selected as the research subjects, and the patients were randomly divided into group A (n = 30, using insulin aspart 30 alone), group B (n = 30, using insulin aspart 30 combined with metformin enteric-coated tablets), and group C (n = 30, using insulin aspart 30 combined with acarbose). The blood glucose balance before meals and before going to bed was maintained in the three groups of patients, and the blood glucose fluctuations, time to target, hypoglycemia, insulin dosage, and daily consumption of the three groups were compared. Results. There was no significant difference in blood glucose and average blood glucose at each time point before treatment in the 3 groups of patients ( P > 0.05 ); compared with the blood glucose and average blood glucose at each time point after reaching the target in the three groups, the blood glucose after dinner in group A was significantly higher than that in groups B and C; at 2 : 00, the blood glucose of group A was significantly higher than that of group B ( P < 0.05 ); there was no significant difference in blood glucose and average blood glucose at other time points ( P > 0.05 ). There was no significant difference in blood glucose standard deviation, LAGE, and PPGE at each point in the three groups before treatment ( P > 0.05 ); the standard deviation of blood glucose, LAGE, and PPGE at each point of the three groups of patients after reaching the standard were compared with those in the same group before treatment, and the differences were statistically significant ( P < 0.05 ); there were statistically significant differences in blood glucose standard deviation, LAGE, and PPGE among the 3 groups after reaching the standard ( P < 0.05 ). Compared among the three groups, the standard deviation of blood glucose and LAGE level at each point after reaching the standard, the difference between group B, group C, and group A was statistically significant ( P < 0.05 ); however, there was no significant difference between the patients in group B and group C ( P > 0.05 ); the level of PPGE in group A was higher than that in group B, which was higher than group C, and between group C and group A, the difference was statistically significant ( P < 0.05 ). The time of reaching the standard in 3 groups was statistically significant ( P < 0.05 ); there was no significant difference in the time of reaching the standard between group B and group C ( P > 0.05 ). There was no significant difference in the incidence of hypoglycemia among the 3 groups ( P > 0.05 ); there were significant differences in the proportion of insulin twice a day among the three groups ( P < 0.05 ); there were statistically significant differences in daily insulin dosage among the 3 groups after reaching the standard ( P < 0.05 ). The daily consumption of the three groups of patients after reaching the standard was compared, the difference was statistically significant ( P < 0.05 ), and there was no significant difference between group A and group B ( P > 0.05 ). Conclusion. The effect of insulin aspart 30 alone in the treatment of diabetic patients is not good, it will lead to a large fluctuation of blood sugar in the patient’s body, and the time required to reach the standard is relatively long; the use of insulin aspart 30 combined with metformin enteric-coated tablets or acarbose can effectively reduce the blood sugar fluctuation range of diabetic patients and reduce the number of insulin injections, and insulin aspart 30 combined with metformin en teric-coated tablets can also greatly reduce the daily insulin dosage and daily consumption cost of diabetic patients.

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“…The search terms are presented in Table S1. The search results were discussed by the author group and relevant articles were identified; 19–33 these are summarised in Tables 1 and 2 19–33 …”

Section: Methodsmentioning

confidence: 99%

“…The search terms are presented in Table S1. The search results were discussed by the author group and relevant articles were identified; [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] these are summarised in Tables 1 and 2. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]…”

Section: Methodsmentioning

confidence: 99%

“…In an open‐label, randomised, controlled study, 200 adults with type 2 diabetes and inadequate glycaemic control on premixed human insulin + metformin were switched to a loose combination of GLP‐1RA (exenatide) + insulin glargine or to insulin aspart 70/30 33 . In the 90 patients who were switched from premix therapy to exenatide + insulin glargine, least squares mean reductions were seen from baseline to week 24 in HbA1c (−6.5 mmol/mol [−0.59%]), body weight (−3.5 kg), FPG (−0.83 mmol/L) and total daily insulin dose (−10.7 U/day) (Table 2).…”

Section: Overview Of the Clinical Evidence For Transitioning To A Com...mentioning

confidence: 99%

See 1 more Smart Citation

Transitioning from basal–bolus or premix insulin therapy to a combination of basal insulin and glucagon‐like peptide‐1 receptor agonist in people with type 2 diabetes

Mehta

¹

,

Billings

²

,

Liebl

³

et al. 2022

Diabet Med

7

0

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Aims: Two fixed-ratio combinations (FRCs) of basal insulin and glucagon-like peptide-1 receptor agonist (GLP-1RA) are available for once-daily use in adults with type 2 diabetes. We aimed to review the clinical evidence for the efficacy and safety of changing treatment from a basal-bolus insulin (BBI) regimen or a premix insulin to these combination treatments (fixed-ratio or loose) and provide expert opinion on the practicalities of making such a change. Methods: Relevant clinical and trial evidence and general review articles were identified through a literature review of ProQuest (comprising BIOSIS Previews®, Current Contents® Search, Embase® and MEDLINE®) for articles published between 2009 and 2021. Results:We identified nine articles reporting the results of FRCs, and seven articles reporting results of loose combinations of basal insulin and GLP-1RAs, in people who transitioned treatment from BBI or premix regimens. In most trials, combination treatment led to improved or equivalent glycaemic control, and a reduction in body weight or BMI, versus the original regimens. Some trials reported a reduction in total insulin dose. A few trials reported reduced or unchanged hypoglycaemia rates, or increased patient satisfaction, with combination therapy where these endpoints were examined. We provide guidance on transitioning of treatment and the patient types most likely to benefit. Conclusions:In people not achieving glycaemic control with BBI or premix insulin regimens, an FRC or loose combination of basal insulin and GLP-1RA may improve control, decrease the risk of body weight gain or hypoglycaemia and reduce the complexity of treatment.

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Exenatide Twice Daily Plus Glargine Versus Aspart 70/30 Twice Daily in Patients With Type 2 Diabetes With Inadequate Glycemic Control on Premixed Human Insulin and Metformin

Cited by 5 publications

References 20 publications

The efficacy and safety of combined GLP-1RA and basal insulin therapy among inadequately controlled T2D with premixed insulin therapy

The efficacy and safety of combined GLP-1RA and basal insulin therapy among inadequately controlled T2D with premixed insulin therapy

Comparative Analysis of Clinical Effects of Insulin Aspart Combined with Acarbose and Metformin in the Treatment of Diabetes Mellitus

Transitioning from basal–bolus or premix insulin therapy to a combination of basal insulin and glucagon‐like peptide‐1 receptor agonist in people with type 2 diabetes

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