Basal insulin and GLP-1 receptor agonists:A complementary approach to achievement of glycemic control

摘要

Today,we are fortunate to have multiple therapeutic agents that address the pathophysiologic defects resulting in hyperglycemia in type 2 diabetes. Evidence from clinical trials,as well as experience in practice, support recent treatment guidelines which call for the early combination of agents with complementary mechanisms of action to help patients achieve and maintain individualized glycemic targets. In patients with type 2 diabetes not achieving adequate glycemic control despite the addition of basal insulin,one such combination that has been shown to be safe and effective in multiple clinical trials, is the combination of basal insulin and a glucagon-like peptide 1 receptor agonist(GLP-1 RA). Through complimentary mechanisms of action,this regimen improves glycemic control and does so with significantly less hypoglycemia and with favorable effects on body weight compared with the addition of rapid-acting insulin(e.g.,basal-bolus insulin regimen). The addition of a GLP-1 RA should therefore be considered in patients with type 2 diabetes suboptimally controlled with basal insulin.