Role of incretin-based therapies and sodium-glucose co-transporter-2 inhibitors as adjuncts to insulin therapy in Type 2 diabetes, with special reference to IDegLira

Wilding, JPH ORCID: 0000-0003-2839-8404 and Bain, SC (2016) Role of incretin-based therapies and sodium-glucose co-transporter-2 inhibitors as adjuncts to insulin therapy in Type 2 diabetes, with special reference to IDegLira. DIABETIC MEDICINE, 33 (7). pp. 864-876.

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Abstract

The progressive nature of Type 2 diabetes necessitates treatment intensification over time in order to maintain glycaemic control, with many patients ultimately requiring insulin therapy. While insulin has unlimited potential efficacy, its initiation is often delayed and improvements in glycaemic control are typically accompanied by weight gain and an increased risk of hypoglycaemia, particularly as HbA1c approaches and falls below target levels. This may account for the sub-optimal control often achieved after insulin initiation. Combining insulin with antihyperglycaemic therapies that have a low risk of hypoglycaemia and are weight-neutral or result in weight loss is a therapeutic strategy with the potential to improve Type 2 diabetes management. Although the effects differ with each individual class of therapy, clinical trials have shown that adding a glucagon-like peptide-1 receptor agonist, dipeptidyl peptidase-4 inhibitor or sodium-glucose co-transporter-2 inhibitor to insulin regimens can offer a significant reduction in HbA1c without substantially increasing hypoglycaemia risk, or weight. The evidence and merit of each approach are reviewed in this paper. Once-daily co-formulations of a basal insulin and a glucagon-like peptide-1 receptor agonist have been developed (insulin degludec/liraglutide) or are under development (lixisenatide/insulin glargine). Insulin degludec/liraglutide phase III trials and a lixisenatide/insulin glargine phase II trial have shown robust HbA1c reductions, with weight loss and a low risk of hypoglycaemia. With insulin degludec/liraglutide now approved in Europe, an important consideration will be the types of patients who may benefit most from a fixed-ratio combination; this is discussed in the present review, and we also take a look toward future developments in the field.

Item Type:	Article
Uncontrolled Keywords:	Humans, Diabetes Mellitus, Type 2, Hypoglycemia, Insulin, Insulin, Long-Acting, Blood Glucose, Peptides, Drug Combinations, Hypoglycemic Agents, Drug Therapy, Combination, Sodium-Glucose Transporter 2, Clinical Trials as Topic, Incretins, Dipeptidyl-Peptidase IV Inhibitors, Glucagon-Like Peptide-1 Receptor, Liraglutide, Insulin Glargine, Sodium-Glucose Transporter 2 Inhibitors, Glycated Hemoglobin
Depositing User:	Symplectic Admin
Date Deposited:	03 Apr 2017 10:35
Last Modified:	13 Feb 2023 21:18
DOI:	10.1111/dme.13021
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3006774