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Got It, Hide thisEng C, Kramer CK, Zinman B, et al. 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 Sep 11. pii: S0140-6736(14)61335-0.
In people with type 2 diabetes, do glucagon-like peptide-1 (GLP-1) agonist drugs combined with basal insulin control blood sugar levels and weight gain better than other antidiabetic treatments?
Type 2 diabetes is a chronic (long-term) disorder that affects how your body processes sugar (glucose) and other nutrients. Initially, you may be able to manage your diabetes by watching your diet and exercising regularly. However, most people with diabetes will eventually have to use medication, and that may include insulin.
Insulin is initially injected once or twice a day to keep blood sugar levels stable (basal insulin). Sometimes it is also taken as single doses before meals (bolus insulin). Insulin sometimes lowers blood sugar levels too much (hypoglycemia) and can cause weight gain.
GLP-1 agonists are newer, injectable drugs that may help better control blood sugar levels and reduce weight gain.
The researchers did a systematic review, searching for studies that were published up to July 2014.
They found 15 randomized controlled trials with 4,348 people (average age 43 to 61 years, 51% men).
The key features of the studies were:
Compared with other antidiabetic treatments, GLP-1 agonists plus basal insulin:
In people with type 2 diabetes, GLP-1 agonist drugs plus insulin reduce weight and lower blood sugar levels.
Outcomes | Number of trials and people | Rate of events with GLP-1 agonist plus insulin | Rate of events with control | Absolute effect of GLP-1 agonist plus insulin |
Hemoglobin A1c level less than or equal to 7.0% | 14 trials (4,267 people) | 59% | 31% | About 28 more people in 100 reached this goal (from as few as 13 to as many as 48) |
Hypoglycemia | 11 trials (3,356 people) | 27.6% | 27.9% | No difference in effect† |
Hemoglobin A1c level | 15 trials (4,348 people) | Does not apply | Does not apply | Reduced by 0.44% (from as little as 0.29% to as much as 0.60%) |
Weight | 12 trials (3,941 people) | Does not apply | Does not apply | Reduced by 3.2 kg (from as little as 1.5 kg to as much as 4.9 kg) |