Insulin, GLP-1 RA Combo Improves Blood Sugar Control for Diabetics

June 24, 2020 - New data from real-world evidence suggests that simultaneous insulin and GLP-1 RA therapies could provide more effective blood sugar control in patients with uncontrolled type 2 diabetes.

Researchers found that starting both insulin and GLP-1 RA before or at 90 days led to more patients achieving blood sugar levels of less than seven or eight percent, and patients reduced their blood sugar levels by less than or equal to 1 to 2 percent at six and 12 months.

These findings were compared with starting the therapies more than three months to one year apart. 

“In my practice, individuals with high blood sugar levels, particularly those over 9 percent, are at high risk for developing comorbidities due to the progressive nature of diabetes associated with advanced disease,” Juan Frias, MD, president and principal investigator of the national research institute in Los Angeles, California, and an investigator of the study, said in the study. 

“A benefit of real-world evidence is that it provides insight into the effectiveness of therapies in real-life practice. In this study, the real-world data shows the potential benefits that starting simultaneous insulin and GLP-1 RA therapies early could have on adults with severely uncontrolled type 2 diabetes.”

Real-world evidence data was compiled from the Optum Humedica database of electronic medical records and claims from 2011 to 2017, a diverse data set representative of the US population, researchers said. 

Patients were prescribed either long-acting or intermediate-acting insulin. 

“Patients with uncontrolled type 2 diabetes, specifically those with blood sugar levels greater than 1.5-2 percent above goal, represent a clinical challenge, and ADA treatment guidelines suggest initiating combination therapy for these patients,” said Rogelio Braceras, MD, North America medical head of general medicines of Sanofi, which supported the study. 

“The complementary actions of a GLP-1 RA and an insulin, when initiated simultaneously, may provide an effective approach for adults with uncontrolled type 2 diabetes. Sanofi is dedicated to providing the diabetes community with robust real-world evidence to ensure healthcare professionals and patients can make informed treatment decisions that meet each person’s individual needs.”

Novo Nordisk released results from its two studies, EXPERT and PATHWAY, which both showed that people with type 2 diabetes on two antidiabetic drugs intensified with a glucagon-like peptide-1 receptor agonist (GLP-1 RA) were more likely to reach their blood sugar goals and lose weight compared to adding a further oral antidiabetic drug or insulin.

The EXPERTS study showed HbA_1c reductions of 2.2 percent for people with HbA_1c levels above 9 percent at baseline and HbA_1c reductions of 1.1 percent for those with HbA_1c levels above 7 percent at baseline.  

Average weight loss of 2.2 kg was observed at 6 months, but was more pronounced with 3.5 kg at 12 months, for all participants.

The PATHWAY study showed that intensifying treatment with a GLP-1 RA resulted in a substantial increased likelihood of achieving HbA_1c below 7 percent and weight reduction from baseline compared with adding further oral antidiabetics.

“GLP-1 receptor agonists have been shown to safely lower blood glucose levels and help lower weight, therefore they are recommended by all diabetes treatment guidelines as either second- or third-line treatment options in most people with type 2 diabetes,” Ildiko Lingvay, MD, study investigator, who consults for Novo Nordisk and professor of internal medicine, and population and data sciences at UT Southwestern Medical Center, said in the study.

“These data provide information from the real-world use of GLP-1 receptor agonists and further support the recommendations in the clinical guidelines by showing that initiation of a GLP-1 receptor agonist helps more people with type 2 diabetes reach their blood sugar goals while also helping them lose weight.”