De-intensification of bolus insulin in type 2 diabetes after GLP-1 RA initiation improves blood sugar and aids weight loss

Against the above background, Cristina Bianchi, Department of Medicine, University Hospital of Pisa, Pisa, Italy, and colleagues conducted a study to investigate the impact of glucagon-like peptide-1 receptor agonist (GLP-1 RA) addition in type 2 diabetes patients in basal-bolus (BB) insulin regimen, on HbA1c, insulin requirement, weight loss up to 24 months.

For this purpose, the researchers retrospectively collected data on T2D patients on BB who initiated a GLP-1 RA. The recording of body weight, HbA1c, and insulin dose was done at baseline 6, 12, and 24 months following GLP-1 RA therapy initiation. Changes in body weight, HbA1c, and insulin requirement were evaluated over time.

The main findings of the study include:

• 156 participants (63.5% males; age 62 ± 11 years, HbA1c 70 ± 22.0 mmol/mol; 8.6 ± 4.2%) were included.
• HbA1c and body weight compared to baseline was significantly lower at six months after GLP-1RA introduction and remained stable up to 24 months.
• At 24 months, 81% of subjects discontinued prandial insulin, while 38.6% discontinued basal insulin.
• Insulin requirement at baseline (aOR 0.144) was the only significant predictor of prandial insulin discontinuation.

Replacing prandial insulin with GLP-1 RA is a valuable strategy to simplify the BB insulin regimen while improving glycaemic control and promoting weight loss in subjects with T2D.

Reference:

Falcetta P, Nicolì F, Citro F, Ciccarone A, Garofolo M, Del Prato S, Bianchi C. De-intensification of basal-bolus insulin regimen after initiation of a GLP-1 RA improves glycaemic control and promotes weight loss in subjects with type 2 diabetes. Acta Diabetol. 2022 Sep 27. doi: 10.1007/s00592-022-01974-0. Epub ahead of print. PMID: 36166172.