Addition of Insulin Glargine to GLP-1 RA Therapy Improved T2D Glycemic Control

May 11, 2022
Connor Iapoce

Connor Iapoce is an associate editor for HCPLive and joined the MJH Life Sciences team in April 2021. He graduated from The College of New Jersey with a degree in Journalism and Professional Writing. He enjoys listening to records, going to concerts, and playing with his cat Squish. You can reach him at ciapoce@mjhlifesciences.com.

In patients with T2D, adding Gla-300 to GLP-1 RA significantly improved glycemic control without significantly increasing hypoglycemia.

New findings suggest the addition of insulin glargine 300 U/ml (Gla-300) to glucagon-like peptide 1 receptor agonist (GLP-1 RA) therapy significantly improved glycemic control in patients with type 2 diabetes (T2D), without significantly increasing hypoglycemia.

These observations found improvement in glycemic control was seen regardless of the use of daily or weekly GLP-1 RAs, or the baseline HbA1c of the patient.

“Observations support [American Diabetes Association/European Association for the Study of Diabetes] guidelines, noting that insulin should be added to GLP-1 RA for people with T2DM with inadequate glycaemic control requiring treatment intensification,” wrote study author Timothy S Bailey, MD, AMCR Institute.

Although previous clinical studies have identified improved glycemic control and low risk of hypoglycemia with combination of insulin and GLP-1 RA, there remains a gap in knowledge from their use in real-world clinical practice, according to the study authors. Investigators additionally noted a lack of data on outcomes for those who received basal insulins after experiencing suboptimal glycemic control during GLP-1 RA therapy.

The current retrospective analysis of US electronic medical record data sources took place between March 2014 - March 2020, including more than 4 million individuals with T2D from outpatient, inpatient, and post-acute care settings. Investigators identified insulin-naive adults receiving GLP-1 RA therapy and Gla-300 between March 3015 - September 2019. They were required to have data for ≥12 months before index date and ≥6 months following the index date, with a validated glycated HbA1c of 3 - 15%.

A total of 271 patients with a mean age of 57.9 years and a baseline HbA1c of 9.16% were identified. The investigators observed 156 (57.6%) patients received daily GLP-1 RAs and 115 (42.4%) received weekly GLP-1 RAs before treatment intensification with Gla-300.

Data show HbA1c was significantly reduced after treatment intensification with the addition of Gla-300 (-0.97 ± 1.6%; P <.0001). Investigators additional found a significant increase in the proportion of patients with T2D achieving HbA1c after the addition of Gla-300 (HbA1c <7.0%: 4.80% vs 22.14%; P <.0001; HbA1c <8.0%: 19.56% vs 51.29%, P <.0001).

Investigators noted no changes in overall incidence or event rate of hypoglycemia were observed following the addition of Gla-300. The incidence of overall (8.49% vs 9.59%, P = .513) and inpatient/emergency department-associated hypoglycemia (0.37% vs 0.74%, P = 1.000) were similar before and after the addition of Gla-300. Additionally, the incidence of overall (0.33 vs. 0.46 per person per year [PPPY], P = .170) and inpatient/ED-associated hypoglycemia events (0.01 vs 0.04 PPPY, P = .466) were similar before and after the addition of Gla-300, investigators found.

“The findings from this real-world study warrant further assessment of the effect of adding Gla-300 to GLP-1 RA therapy in patients with T2D,” Bailey concluded.

The study, “Real-world outcomes of addition of insulin glargine 300 U/mL (Gla-300) to GLP-1 RA therapy in people with type 2 diabetes: The DELIVER-G study,” was published in Diabetes, Obesity and Metabolism.


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