scholarly journals Impact of a Weekly Glucagon-Like Peptide 1 Receptor Agonist, Albiglutide, on Glycemic Control and on Reducing Prandial Insulin Use in Type 2 Diabetes Inadequately Controlled on Multiple Insulin Therapy: A Randomized Trial

Diabetes Care ◽  
2020 ◽  
Vol 43 (10) ◽  
pp. 2509-2518 ◽  
Author(s):  
Julio Rosenstock ◽  
Antonio Nino ◽  
Joseph Soffer ◽  
Lois Erskine ◽  
Andre Acusta ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Randomized Trial ◽  
Receptor Agonist ◽  
Prandial Insulin ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Insulin Use

scholarly journals Impact of a Weekly Glucagon-Like Peptide 1 Receptor Agonist, Albiglutide, on Glycemic Control and on Reducing Prandial Insulin Use in Type 2 Diabetes Inadequately Controlled on Multiple Insulin Therapy: A Randomized Trial

2020 ◽  
Author(s):  
Julio Rosenstock ◽  
Antonio Nino ◽  
Joseph Soffer ◽  
Lois Erskine ◽  
Andre Acusta ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Receptor Agonist ◽  
Insulin Dose ◽  
Treat To Target ◽  
Prandial Insulin ◽  
Glucagon Like Peptide 1 ◽  
Multiple Daily Insulin Injections ◽  
Design And Methods

<b>Objective: </b>The principle of replacing prandial insulin lispro with a once-weekly GLP-1 receptor agonist (GLP-1RA) in type 2 diabetes inadequately controlled on a multiple daily insulin injections regimen was tested with albiglutide. <p> </p> <p><b>Research Design and Methods</b>: In this treat-to-target study, basal+prandial insulin was optimized over 4 weeks before participants were randomized (1:1) to albiglutide plus optimized basal insulin glargine and lispro (dose reduced by 50% at randomization; subsequently lispro injections were fully discontinued 4 weeks later) (n=402), or to continued optimized lispro plus optimized glargine (n=412).</p> <p> </p> <p><b>Results<a>:</a></b> <a>Mean±SD HbA<sub>1c</sub> at baseline, 7.8±0.6% (61±7 mmol/mol) in the albiglutide+glargine group and 7.7±0.6% (60±7 mmol/mol) in the lispro+glargine group, were reduced at week 26 to 6.7±0.8% (49±8 mmol/mol) and 6.6±0.8% (48±8 mmol/mol); respectively (LS difference 0.06% [95% CI, −0.05 to 0.17]; noninferiority <i>P</i><0.0001)</a>. In the albiglutide+glargine group, 218 participants (54%) replaced all prandial insulin without reintroducing lispro up to week 26. Total daily prandial insulin dose was similar at baseline but was lower by 62U/day (95% CI −65.9 to −57.8; <i>P</i><0.0001) at week 26 in the albiglutide+glargine group <a></a> and the total number of weekly injections was also reduced from 29 to 13 per week. Less severe/documented symptomatic hypoglycemia (57.2% vs. 75.0%) occurred in the albiglutide+glargine group with meaningful weight differences (LS mean±SE: −2.0±0.2 vs. +2.4±0.2 kg; <i>P</i><0.0001) vs. lispro+glargine. Gastrointestinal adverse events were higher with albiglutide+glargine (26% vs. 13%). </p> <p> </p> <p><b>Conclusions<a>:</a></b> A once-weekly GLP-1RA was able to substitute for prandial insulin in 54% of people, substantially reducing the number of prandial insulin injections; glycemic control improved, with the added benefits of weight loss and less hypoglycemia in the GLP1RA arm. Replacing prandial insulin with a weekly GLP-1RA can simplify basal+prandial insulin treatments and achieve better outcomes in type 2 diabetes. </p>

scholarly journals Impact of a Weekly Glucagon-Like Peptide 1 Receptor Agonist, Albiglutide, on Glycemic Control and on Reducing Prandial Insulin Use in Type 2 Diabetes Inadequately Controlled on Multiple Insulin Therapy: A Randomized Trial

2020 ◽  
Author(s):  
Julio Rosenstock ◽  
Antonio Nino ◽  
Joseph Soffer ◽  
Lois Erskine ◽  
Andre Acusta ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Receptor Agonist ◽  
Insulin Dose ◽  
Treat To Target ◽  
Prandial Insulin ◽  
Glucagon Like Peptide 1 ◽  
Multiple Daily Insulin Injections ◽  
Design And Methods

<b>Objective: </b>The principle of replacing prandial insulin lispro with a once-weekly GLP-1 receptor agonist (GLP-1RA) in type 2 diabetes inadequately controlled on a multiple daily insulin injections regimen was tested with albiglutide. <p> </p> <p><b>Research Design and Methods</b>: In this treat-to-target study, basal+prandial insulin was optimized over 4 weeks before participants were randomized (1:1) to albiglutide plus optimized basal insulin glargine and lispro (dose reduced by 50% at randomization; subsequently lispro injections were fully discontinued 4 weeks later) (n=402), or to continued optimized lispro plus optimized glargine (n=412).</p> <p> </p> <p><b>Results<a>:</a></b> <a>Mean±SD HbA<sub>1c</sub> at baseline, 7.8±0.6% (61±7 mmol/mol) in the albiglutide+glargine group and 7.7±0.6% (60±7 mmol/mol) in the lispro+glargine group, were reduced at week 26 to 6.7±0.8% (49±8 mmol/mol) and 6.6±0.8% (48±8 mmol/mol); respectively (LS difference 0.06% [95% CI, −0.05 to 0.17]; noninferiority <i>P</i><0.0001)</a>. In the albiglutide+glargine group, 218 participants (54%) replaced all prandial insulin without reintroducing lispro up to week 26. Total daily prandial insulin dose was similar at baseline but was lower by 62U/day (95% CI −65.9 to −57.8; <i>P</i><0.0001) at week 26 in the albiglutide+glargine group <a></a> and the total number of weekly injections was also reduced from 29 to 13 per week. Less severe/documented symptomatic hypoglycemia (57.2% vs. 75.0%) occurred in the albiglutide+glargine group with meaningful weight differences (LS mean±SE: −2.0±0.2 vs. +2.4±0.2 kg; <i>P</i><0.0001) vs. lispro+glargine. Gastrointestinal adverse events were higher with albiglutide+glargine (26% vs. 13%). </p> <p> </p> <p><b>Conclusions<a>:</a></b> A once-weekly GLP-1RA was able to substitute for prandial insulin in 54% of people, substantially reducing the number of prandial insulin injections; glycemic control improved, with the added benefits of weight loss and less hypoglycemia in the GLP1RA arm. Replacing prandial insulin with a weekly GLP-1RA can simplify basal+prandial insulin treatments and achieve better outcomes in type 2 diabetes. </p>

scholarly journals A practical Guide to Treatment with Liraglutide

2010 ◽  
Vol 2 ◽  
pp. CMT.S4148 ◽  
Author(s):  
Devasenan Devendra ◽  
Vassiliki Bravis
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Body Weight ◽  
Glycemic Control ◽  
Receptor Agonist ◽  
Efficacy And Safety ◽  
Once Daily ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1

Liraglutide–-a once-daily human glucagon-like peptide-1 receptor agonist for treatment of Type 2 diabetes–-provides effective glycemic control with a lower incidence of hypoglycemia than therapies such as glimepiride and exenatide, and reduces body weight and systolic blood pressure. This article briefly discusses efficacy and safety results from the Liraglutide Effect and Action in Diabetes (LEAD) program, before considering practical issues of identifying and educating patients who may be suitable for liraglutide therapy.

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