Regimen comprising GLP-1 receptor agonist and basal insulin can decrease the effect of food on glycemic variability compared to a pre-mixed insulin regimen

Abstract

Background Increasing evidence suggests that glucagon-like peptide 1 (GLP-1) receptor agonists (RA) can stabilize glycemic variability (GV) and interfere with eating behavior. This study compared the impact of insulin, GLP-1 RA, and dietary components on GV using professional continuous glucose monitoring (CGM). Methods Patients with type 2 diabetes underwent CGM before and after switching from a twice-daily pre-mixed insulin treatment regimen to a GLP-1 RA (liraglutide) plus basal insulin regimen. The dietary components were recorded and analyzed by a certified dietitian. The interactions between the medical regimen, GV indices, and nutrient components were analyzed. Results Sixteen patients with type 2 diabetes were enrolled in this study. No significant differences in the diet components and total calorie intake between the two regimens were found. Under the pre-mixed insulin regimen, for increase in carbohydrate intake ratio, mean amplitude of glucose excursion (MAGE) and standard deviation (SD) increased; in contrast, under the new regimen, for increase in fat intake ratio, MAGE and SD decreased, while when the protein intake ratio increased, the coefficient of variation (CV) decreased. The impact of the food intake ratio on GV indices disappeared under the GLP-1 RA regimen. After switching to the GLP-1 RA regimen, the median MAGE, SD, and CV values decreased significantly. However, the significant difference in GV between the two regimens decreased during the daytime. Conclusion A GLP-1 RA plus basal insulin regimen can stabilize GV better than a regimen of twice-daily pre-mixed insulin, especially in the daytime, and can diminish the effect of food components on GV.

Mechanism of GLP-1 Receptor Agonists-Mediated Attenuation of Palmitic Acid-Induced Lipotoxicity in L6 Myoblasts

“…Cell Viability. Cell viability was reduced in the high fatgroup (average SI = 2:70) relative to the control group (average SI = 2:17) (2:17 ± 0:06 vs. 2:70 ± 0:08, P < 0:01), of the 10LR group (average SI = 2:63) did not differ from the high-fat group (2:63 ± 0:12 vs. 2:70 ± 0:08, P > 0:05), but both the 100LR (average SI = 2:64) and 1000LR (average SI = 2:50) groups had higher cell viability (P < 0:01) [10,11]. Cell viability highest in the 100LR group (P < 0:05).…”

“…The high-fat and LR-intervention groups were cultured in MEM supplemented with PA at 0.6 mmol/L. The medium of the LR-intervention groups was additionally supplemented with LR at 10 nmol/L (10LR), 100 nmol/L (100LR), or 1000 nmol/L (1000LR) [10][11][12].…”

Glycaemia in low-premixed insulin analogue type 2 diabetes patients in a real-world setting: are the CGM targets met?

“…Wang et al measured average TBR < 3.9 mmol/l of 9.4% for a premixed insulin group ( n = 194) [ 26 ], and Margaritidis et al the value of 6.3% in a well-controlled group ( n = 36) [ 27 ]. Lin et al reported a TBR value of 0 for their 16 premix patients [ 29 ].…”

“…Wang et al showed a similar TIR of 59.8% for their group [ 26 ]. Lin et al reported a TIR of 39.0% for premix-treated patients [ 29 ], and Margaritidis et al measured a value of 74.2% [ 27 ]. The TAR target for high-risk people was met in 77% of our group.…”

“…In the study by Margaritidis et al, TAR was 19.6% in a well-controlled group [ 27 ]. Lin et al reported a TAR of 61.0% [ 29 ]. The general glycaemic variability target was met in 80% of our patients.…”