The Impact of GLP-1 Receptor Agonists on Patients with Diabetes on Insulin Therapy

Gyorffy, Janelle; Keithler, Andrea N.; Wardian, Jana L.; Zarzabal, Lee Ann; Rittel, Alexander G; True, Mark W.

doi:10.4158/ep-2019-0023

Cited by 7 publications

(20 citation statements)

References 16 publications

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“…The magnitude of impact on glycemia was greatest in the first 6 months, where we observed mean decreases in A1c of −0.7% in the primary analysis and −0.8% in the secondary analysis. This finding was similar to two previous observational studies, which reported A1c reductions of −0.66% (baseline 8.0%) and −0.7% (baseline 8.7%) at 6 months following GLP‐1‐RA addition to basal‐bolus insulin 10,11 . A third observational study by Rose et al reported a substantially higher mean A1c decrease of −1.8% in patients receiving basal‐bolus insulin at 6–12 months following GLP‐1‐RA initiation 12 .…”

Section: Discussionsupporting

confidence: 89%

“…Our findings support this concept as mean A1c change declined from −0.5% at 3 months following GLP‐1‐RA initiation to −0.7% at 6 months and remained at −0.7% at 12 months. The maintenance of stable A1c values between 6 and 12 months of therapy has also been noted by other observational studies 10,11 …”

Section: Discussionsupporting

confidence: 68%

“…Second, patients who discontinued bolus insulin lost significantly more weight, a mean of −4.1 kg at 12 months. The degree of weight loss at 12 months has been variable across observational studies, from −1.2 to −4.3 kg, and is certainly multifactorial in uncontrolled treatment settings, but the degree of insulin dose reduction likely plays an important role 10‐12 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Several years later, two small controlled trials, with a total sample of just over 100 patients, reported a significant reduction in A1c with the addition of once‐daily liraglutide to basal‐bolus insulin 3,9 . Uncontrolled observational studies have also reported reductions in A1c and weight following the addition of a GLP‐1‐RA to basal‐bolus insulin regimens but have generally involved a small number of sites, totaling less than 250 patients 10‐12 . In 2020, authors published an exploratory subgroup analysis using data from a phase 4, randomized, placebo‐controlled trial of once‐weekly dulaglutide and various insulin therapies in patients with type 2 diabetes in Japan.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Impact of GLP‐1 receptor agonists in veterans receiving basal‐bolus insulin

et al. 2021

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Background In 2017, an estimated 7.4 million Americans used insulin to treat diabetes. Insulin is proven to lower A1c but can result in hypoglycemia and weight gain. Combining insulin with a glucagon‐like peptide‐1 receptor agonist (GLP‐1‐RA) may provide additional blood glucose control while limiting undesirable effects including weight gain. Objective To characterize the clinical impact of adding a GLP‐1‐RA to a basal‐bolus insulin regimen in patients with type 2 diabetes. Methods This retrospective observational study used national Veteran's Health Administration data to identify patients with an existing basal‐bolus insulin regimen who initiated a GLP‐1‐RA between January 1, 2005 and December 31, 2017. A1c, insulin total daily dose (TDD), and weight were collected at GLP‐1‐RA initiation (baseline), 3‐, 6‐, and 12‐month time points and then analyzed using an intent‐to‐treat approach with the last observation carried forward. Decreases in A1c ≥ 0.5% and weight ≥2 kg were deemed clinically significant. Results Among 7651 patients initiating GLP‐1‐RA therapy, mean A1c had a clinically significant decline at 3, 6, and 12 months by −0.5%, −0.7%, and −0.7%, respectively, from a mean baseline of 9%. Patients with lower baseline A1c levels did not have clinically significant changes in A1c, whereas patients with baseline A1c ≥9% had more clinically significant declines. Insulin TDD decreased by −32, −38, and −42 units/day at 3, 6, and 12 months, respectively, where the mean decrease in insulin TDD at 12 months was 79 units/day among patients who discontinued bolus insulin (52.3%) compared with a mean decrease of 2 units/day among those who continued bolus insulin. Mean weight reductions at 3, 6, and 12 months were −1.2, −2.3, and −2.9 kg, respectively, from a mean baseline of 120.6 kg. Conclusion Combining a GLP‐1‐RA with basal‐bolus insulin had a clinically significant improvement on blood glucose control, lowered insulin TDD, and reduced weight. These outcomes were achieved within 3 to 6 months following GLP‐1‐RA initiation and were maintained through 1 year.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Impact of GLP‐1 receptor agonists in veterans receiving basal‐bolus insulin

et al. 2021

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“…For patients on basal/bolus insulin, the glargine and NPH insulin doses did not change significantly, but short-acting insulin doses were reduced on average by 28% (50.4 units to 36.6 units) p < 0.01. 29 Gyorffy et al 30 conducted a retrospective analysis evaluating patients who were using insulin therapy, either basal, U-500, or MDII (basal/bolus), in addition to a GLP-1 RA (exenatide or liraglutide). Data included 113 patients, but this review discusses the subset of patients (n ¼ 54, 48%) who used MDII in addition to a GLP-1 RA.…”

Section: Retrospective Trials Evaluating Glp-1 Ras In Combination Wit...mentioning

confidence: 99%

Evaluation of GLP-1 Receptor Agonists in Combination With Multiple Daily Insulin Injections for Type 2 Diabetes

Sassenrath¹,

Phillips

Stone

2021

Journal of Pharmacy Practice

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Objective: To assess the available literature evaluating the efficacy and safety of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with multiple daily insulin injections (MDII). Data Sources: A literature search of MEDLINE and Embase was performed (2004 to May 2020) using the following search terms: glucagon-like 1 receptor agonist, liraglutide, albiglutide, dulaglutide, exenatide, semaglutide, diabetes mellitus, and prandial insulin or bolus insulin. Additional references were obtained from cross-referencing the bibliographies of selected articles. Study Selection and Data Extraction: All information obtained from the searches were reviewed. All relevant trials are included in this review. Data Synthesis: Eight studies met criteria for inclusion. The addition of a GLP-1 RA to multiple daily insulin injections was associated with a reduction in A1c in 7 out of 8 studies, and weight loss in 5 studies. In studies that allowed insulin adjustment after the addition of GLP-1 RA, the average total daily insulin dose was reduced in 3 studies. When evaluated, hypoglycemia frequency or other adverse events were not increased when GLP-1 RAs were added to MDII. Relevance to Patient Care and Clinical Practice: Guidelines do not offer recommendations regarding the use of GLP-1 RAs in combination with MDII regimens. This review evaluates current studies demonstrating efficacy and safety considerations of this combination. Conclusions: While some studies did demonstrate an improvement in A1c and reduction in insulin doses without increased hypoglycemia, larger randomized controlled trials are needed to adequately assess the benefit and safety of GLP-1 RAs in combination with MDII.

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An Indirect Comparison of Basal Insulin Plus Once-Weekly Semaglutide and Fully Optimised Basal–Bolus Insulin in Type 2 Diabetes

et al. 2022

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Introduction: To date, there have been few head-to-head comparisons between semaglutide once-weekly (OW) and short-acting mealtime insulin in participants with type 2 diabetes (T2D) treated with basal insulin and requiring treatment intensification. This indirect comparison evaluated the effects of these regimens on glycated haemoglobin (HbA 1c ), body weight, hypoglycaemia, and other clinically relevant outcomes. Methods: A post-hoc, unanchored, individual participant data meta-analysis was conducted on the basis of data from single treatment arms in the SUSTAIN 5 and DUAL 7 trials. Semaglutide 0.5 mg OW and 1.0 mg OW plus basal

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The Impact of GLP-1 Receptor Agonists on Patients with Diabetes on Insulin Therapy

Cited by 7 publications

References 16 publications

Clinical Impact of GLP‐1 receptor agonists in veterans receiving basal‐bolus insulin

Clinical Impact of GLP‐1 receptor agonists in veterans receiving basal‐bolus insulin

Evaluation of GLP-1 Receptor Agonists in Combination With Multiple Daily Insulin Injections for Type 2 Diabetes

An Indirect Comparison of Basal Insulin Plus Once-Weekly Semaglutide and Fully Optimised Basal–Bolus Insulin in Type 2 Diabetes

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