Diabetes mellitus type 2 (DM2) is becoming more common in the United States and around the world, owing to rising obesity rates (approximately 40% of adult individuals in the United States). Insulin resistance, which sets the stage 4-7 years before DM type 2 is diagnosed, and insulin insufficiency, which is related to the increased resistance insulin deficiency, are the two major flaws of the disease. Insulin resistance normally remains constant after a diagnosis of DM type 2, while Insulin deficit worsens, necessitating the intensification of therapy and, finally, the use of Insulin. Initially, basal insulin is used, and as the DM type 2 advances, bolus rapid acting insulin is added to the major meal-basal plus regimen/BP/, and then to every meal-basal-bolus /BB/ insulin. This increase of therapy can often control DM type 2, but it comes with a large weight gain of 3-4 kg and a risk of hypoglycemia.
Another approach for DM type 2 therapy intensification is to add solely basal Insulin and GLP1-RAs to the oral anti-diabetic drugs. GLP1-RAs lower postprandial blood sugar in the same way that rapid-acting insulin does, and long-acting GLP1-RAs lower fasting blood sugar as well. GLP1-RAs decrease hunger and, in theory, may lead to weight loss and a lower risk of hypoglycemia than BP/BB insulin regimens, because they function in a glucose-dependent way, increasing endogenous insulin production only when blood sugar levels are high.
Our goal in our meta-analysis was to look at the effect of GLP-1 RAs and basal-insulin combination on blood sugar as well as the side effects of GLP-1 RAs and basal-insulin combination on weight loss/gain, incidence of hypoglycemia, and adverse events—especially gastrointestinal ones—in comparison to BP/BB insulin combination.
The difference in HbA1c between the GLP1-RAs and basal insulin groups compared to the BP/BB insulin group in individuals with HbA1c of 7-11 percent was our secondary end point.
This is the first meta-analysis in terms of comparing those two combinations – BB/BP insulin to GLP1-RAs and basal insulin – in terms of looking at the adverse effects of both combinations as a key end point.Author (S) Details
Andrey Emanuilov Manov
Internal Medicine Residency Program, Department of Internal Medicine, Sunrise Health GME Consortium, Mountain View Hospital, Las Vegas, Touro University, Henderson, Nevada, USA.
Ashan Thomas Hatharasinghe
Internal Medicine Residency Program, Department of Internal Medicine, Sunrise Health GME Consortium, Mountain View Hospital, Las Vegas, Nevada, USA.
Katrina Equinox Lopez
Internal Medicine Residency Program, Department of Internal Medicine, Sunrise Health GME Consortium, Mountain View Hospital, Las Vegas, Nevada, USA.
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