medwireNews: The combination of a glucagon-like peptide (GLP) -1 receptor agonist or a sodium glucose cotransporter (SGLT) 2 inhibitor with basal insulin enables people with type 2 diabetes to be on a basal bolus regimen, prandial insulin to drop, shows the pragmatic BEYOND attempt.
Blood sugar control was similar with all three treatment approaches, but people who switched to the combination treatments had less hypoglycemia and decreased or maintained their body weight instead of increasing it, the researchers report.
Because the two alternative treatment regimens were a combination of a fixed ratio insulin and GLP-1 receptor agonist and basal insulin plus an SGLT2 inhibitor, people who were randomly assigned to these treatments were able to reduce their daily injections from four to just one.
BEYOND’s results challenge “the dogma about the untouchability” of the basal bolus regimen in advanced type 2 diabetes, say Dario Giugliano and co-researcher at the University of Campania “Luigi Vanvitelli” in Naples, Italy.
They add: “To the best of our knowledge, our study is the first to examine the role of simplifying the complex insulin regimen in patients with type 2 diabetes in their current clinical practice beyond any structured support system that is traditionally randomized controlled Studies is connected. “
They note that the pragmatic study design did not allow for an intensive approach to treating the target, where the drugs were instead titrated according to current guidelines. Study participants were only seen at the 3 and 6 month follow-up points, although they received weekly phone calls in between.
All study participants had type 2 diabetes with glycated hemoglobin (HbA1c) levels greater than 7.5% (58 mmol / mol) despite receiving a full basal bolus insulin regimen.
During the 6-month follow-up period, symptomatic hypoglycemia occurred at least once in 7.8% and 5.9% of participants who randomly took the combinations of GLP-1 receptor agonist and SGLT2 inhibitor, compared with 17.8% in those who are on their pre-existing basal bolus regimen.
Participants using the GLP-1 receptor agonist combination had a significant mean reduction in body weight of 1.9 kg and the SGLT2 inhibitor combination group had a nonsignificant decrease of 0.6 kg, while the basal bolus insulin group had one had a non-significant mean of 0.3 kg.
All three treatment regimens used in the study produced similar results for the primary endpoint of change in HbA1c.
In particular, the 102 people who used the GLP-1 receptor agonist combination achieved an average reduction in HbA1c levels of 0.6%, while the 102 people who took the SGLT2 inhibitor combination achieved a 0.7% reduction. These changes were not significantly different from the mean HbA1c reduction of 0.6% observed in 101 subjects on basal bolus insulin.
Corresponding 28%, 27% and 34% achieved HbA1c levels of 7.5% or less, report the researchers from Diabetes Care.
They emphasize, “Although this may not be considered optimal in terms of target achievement, it is the result of a simple therapeutic algorithm that can be used in clinical practice in both outpatient and inpatient departments, over the complexity of somewhat daunting titration protocols out. ”
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Diabetes Care 2021; doi: 10.2337 / dc20-2623