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Fixed-ratio Combination of Basal Insulin and Glucagon-like Peptide 1 Receptor Agonist for the Management of Type 2 Diabetes Mellitus
摘要
Background. For type 2 diabetes (T2D) patients who fail to achieve glycemic control with basal insulin, current guidelines recommend intensification with additional agents, particularly glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Until recently, GLP-1 RAs and basal insulin therapies were only separately available. This present article reviews current clinical evidence on the benefits of using fixed-ratio combinations (FRCs) of basal insulin and GLP-1 RA in the management of T2D and discusses their potential place in therapy. Findings. The LixiLan and DUAL clinical programs demonstrated that FRCs of basal insulin and GLP-1 RA, iGlarLixi (insulin glargine + lixisenatide) and iDegLira (insulin degludec + liraglutide), respectively, provide significantly greater reduction to HbA1c levels at lower doses than their mono-components even when used in conjunction with oral anti-diabetic drugs. When compared to its individual agents, iGlarLixi was demonstrated to provide a greater reduction in 2h postprandial glucose levels in the LixiLan studies, whereas iDegLira displayed a greater effect on fasting plasma glucose levels in the DUAL trials. In terms of weight gain and safety (e.g., risk of gastrointestinal adverse events and hypoglycemia), the FRC therapies were shown to have more favorable effects than basal insulin or GLP-1 RA alone in both clinical programs. Conclusion. FRCs of basal insulin and GLP-1 RA (i.e., iGlarLixi and iDegLira) provide new therapeutic options for better glycemic control with several advantages over their individual agents. Introducing FRCs earlier in clinical T2D management may have great potential to address the unmet medical needs associated with delayed insulin therapy.
延伸閱讀
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