Adding GLP-1 Receptor Agonist Therapy to Basal Insulin for Postprandial Glucose Control.

Abstract

Even with current guidelines, treatment algorithms, and recommendations available regarding diabetes management (1,2), providers struggle with adding therapies to manage postprandial hyperglycemia after basal insulin therapy in combination with oral antidiabetic medications (OADs) has failed to control a patient’s hyperglycemia. Historically, after titration of basal insulin to achieve morning glucose control, adding a bolus, or prandial, rapid-acting insulin analog has been recommended either in a stepwise approach or as a full basal-bolus insulin regimen (3–5). However, recent research has shown that adding a GLP-1 receptor agonist to basal insulin may be as effective as adding prandial insulin therapy (6–8). These results have given providers and patients a potentially easier option when glycemic control is not achieved with basal insulin in combination with OADs. This article summarizes three recent articles demonstrating the glycemic control efficacy and other benefits of adding a GLP-1 receptor agonist to basal insulin and describes a strategy to implement this therapy in busy primary care settings. Article A. Rosenstock J, Fonseca VA, Gross JL, et al.; Harmony 6 Study Group. Advancing basal insulin replacement in type 2 diabetes inadequately controlled with insulin glargine plus oral agents: a comparison of adding albiglutide, a weekly GLP-1 receptor agonist, versus thrice-daily prandial insulin lispro. Diabetes Care 2014;37:2317–2325 Article B. Eng C, Kramer CK, Zinman B, Retnakaran R. Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis. Lancet 2014;384:2228–2234 Article C. …