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Tuesday, September 30, 2014

Combination therapy scores trifecta in type 2 treatment

DIABETES DIGEST – Sept. 30, 2014 – Treatment that combines insulin with one of the newer GLP-1 blockers appears to provide exceptional blood sugar control without weight gain, a new study shows.

The combination treatment had been compared in 15 studies, from which the researchers combined the data and re-analyzed the results in what is called a meta-analysis. The studies included involved 4,348 participants and the re-analysis was published in the Sept. 12, 2014, The Lancet.


GLP-1, or glucagon-like peptide-1 receptor agonists, are a class of injected drugs that work by reducing glucose produced by the liver, stimulates release of insulin and slows stomach digestion. Several versions of this drug include Byetta/Bydureon, Victoza, Lyxumia and Tanzeum.

Managing blood sugar levels is a daily balancing act between being too high, or hyperglycemic, and being too low, hypoglycemic. Overall, the study showed that the combination treatment was 92 percent more effective in achieving that balance. 

The analysis showed that compared with other anti-diabetic treatments, the combination of a GLP-1 agonist and basal insulin improved the average reduction in blood sugar (HbA1c), and improved likelihood of achieving the target HbA1c of 7.0 percent or lower with no increased relative risk of low-blood sugar (hypoglycaemia). In addition, they found that patients had an average weight loss of nearly 13 pounds.

“GLP-1 agonist and basal insulin combination treatment can enable achievement of the ideal trifecta in diabetic treatment: robust glycaemic control with no increased hypoglycaemia or weight gain,” the authors concluded. “This combination is thus a potential therapeutic strategy that could improve the management of patients with type 2 diabetes.”

While there are a number of approved treatments using the combination, the study result has ignited a debate among endocrinologists who treat type 2 diabetes. The question is when should patients be given the combination therapy. Typically patients are given the combination treatment only when other treatments have failed to achieve the correct balance in blood sugar control.


In an editorial in the same issue of the journal, Dr. John Buse, chief of endocrinology at the University of North Carolina School of Medicine in Chapel Hill, N.C, suggests that it might be more beneficial to start patients on the combination treatment earlier, but notes that both GLP-1 agonists and insulin analogs are among the most expensive drugs in diabetes care, which could be a barrier to greater adoption of the combination treatment.

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