De-intensification of basal-bolus insulin regimen after initiation of a GLP-1 RA improves glycaemic control and promotes weight loss in subjects with type 2 diabetes.

Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9200299 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-5233 (Electronic) Linking ISSN: 09405429 NLM ISO Abbreviation: Acta Diabetol Subsets: MEDLINE

Publication: Berlin : Springer Verlag
Original Publication: Berlin : Springer International, c1991-

Diabetes Mellitus, Type 2*/drug therapy; Male ; Humans ; Middle Aged ; Aged ; Female ; Hypoglycemic Agents/therapeutic use ; Glycated Hemoglobin ; Retrospective Studies ; Glycemic Control ; Insulin ; Weight Loss ; Body Weight ; Glucagon-Like Peptide 1/therapeutic use ; Glucagon-Like Peptide-1 Receptor/agonists ; Blood Glucose

Aims: To evaluate the impact of adding a glucagon-like peptide-1 receptor agonist (GLP-1 RA) in people with type 2 diabetes (T2D) in basal-bolus (BB) insulin regimen, on insulin requirement, HbA1c, weight loss up to 24 months.
Methods: Data on subjects with T2D on BB who initiated a GLP-1 RA have been retrospectively collected. HbA1c, body weight, and insulin dose were recorded at baseline, 6, 12, and 24 months after initiation of GLP-1 RA therapy. A linear mixed model for repeated measures was used to evaluate the changes in HbA1c, body weight, and insulin requirement over time.
Results: We included 156 subjects (63.5% males; age 62 ± 11 years, HbA1c 70 ± 22.0 mmol/mol; 8.6 ± 4.2%). Compared to baseline, HbA1c and body weight were significantly lower at 6 months after introducing a GLP-1RA and remained stable up to 24 months (all p < 0.0001 vs. baseline). At 24 months, 81% of subjects discontinued prandial insulin, while 38.6% discontinued basal insulin as well. Insulin requirement at baseline (aOR 0.144; 95% CI, 0.046-0.456; P = 0.001) was the only significant predictor of prandial insulin discontinuation.
Conclusions: Replacing prandial insulin with GLP-1 RA is a valuable strategy to simplify the BB insulin regimen while improving glycaemic control and promoting weight loss in subjects with T2D.
(© 2022. Springer-Verlag Italia S.r.l., part of Springer Nature.)

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Keywords: Basal-bolus; De-intensification; Glucagon-like peptide-1 receptor agonist; Insulin therapy

0 (Hypoglycemic Agents)
0 (Glycated Hemoglobin)
0 (Insulin)
89750-14-1 (Glucagon-Like Peptide 1)
0 (Glucagon-Like Peptide-1 Receptor)
0 (Blood Glucose)

Date Created: 20220927 Date Completed: 20230106 Latest Revision: 20230111

20240628

10.1007/s00592-022-01974-0

36166172