GLP-1 agonist plus basal insulin beat other diabetes treatment regimens in meta-analysis

Patients on combination treatment with a glucagon-like peptide-1 receptor (GLP-1) agonist and basal insulin had better HbA1c values, less weight gain, and similar hypoglycemia rates compared to patients on other type 2 diabetes treatment regimens, a recent analysis of previous trials found.

Researchers included 15 randomized, controlled trials with 4,348 patients comparing the GLP-1 agonist/basal insulin combination to other treatments in a systematic review and meta-analysis. Compared with other treatments, GLP-1 agonist/basal insulin was associated with a 0.44% decrease in mean HbA1c (95% CI, −0.60% to −0.29%), an almost doubled likelihood of achieving an HbA1c ≤7.0% (relative risk [RR], 1.92; 95% CI, 1.43 to 2.56), similar risk of hypoglycemia (RR, 0.99; 95% CI, 0.76 to 1.29), and a mean reduction in weight of 3.22 kg (95% CI, −4.90 kg to −1.54 kg).

Specifically compared with a basal-bolus regimen, the combination treatment was associated with a 0.1% drop in HbA1c (95% CI, −0.17% to −0.02%), a 0.67 RR of hypoglycemia (95% CI, 0.56 to 0.80), and a 5.66-kg drop in weight (95% CI, −9.8 kg to −1.51 kg). The study authors concluded that the GLP-1 agonist/basal insulin combination “can enable achievement of the ideal trifecta in diabetic treatment: robust glycaemic control with no increased hypoglycaemia or weight gain.”

The analysis was limited by several factors, including the uncertain durability of the treatment effect, the risk of bias in included studies, the lack of information about differences between GLP-1 agonist preparations, and no data about the ideal time to initiate this treatment. Future studies should investigate these questions, but based on the current evidence, the GLP-1 agonist/basal insulin combination appears to be a therapeutic strategy that could improve management of type 2 diabetes, the authors concluded.

An accompanying editorial agreed that more information is needed about the effects of short-acting versus long-acting GLP-1 agonists. The editorialist also noted that the biggest barrier to adoption of the combination is cost, because both drug types are among the most expensive in diabetes care. The study and editorial were published online by The Lancet on Sept. 12.