Department of Pharmacy, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.
Center for Access & Delivery Research and Evaluation and Department of Pharmacy, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA.
Pharmacotherapy. 2022 Jan;42(1):45-52. doi: 10.1002/phar.2648. Epub 2021 Dec 3.
In 2017, an estimated 7.4 million Americans used insulin to treat diabetes. Insulin is proven to lower A1c but can result in hypoglycemia and weight gain. Combining insulin with a glucagon-like peptide-1 receptor agonist (GLP-1-RA) may provide additional blood glucose control while limiting undesirable effects including weight gain.
To characterize the clinical impact of adding a GLP-1-RA to a basal-bolus insulin regimen in patients with type 2 diabetes.
This retrospective observational study used national Veteran's Health Administration data to identify patients with an existing basal-bolus insulin regimen who initiated a GLP-1-RA between January 1, 2005 and December 31, 2017. A1c, insulin total daily dose (TDD), and weight were collected at GLP-1-RA initiation (baseline), 3-, 6-, and 12-month time points and then analyzed using an intent-to-treat approach with the last observation carried forward. Decreases in A1c ≥ 0.5% and weight ≥2 kg were deemed clinically significant.
Among 7651 patients initiating GLP-1-RA therapy, mean A1c had a clinically significant decline at 3, 6, and 12 months by -0.5%, -0.7%, and -0.7%, respectively, from a mean baseline of 9%. Patients with lower baseline A1c levels did not have clinically significant changes in A1c, whereas patients with baseline A1c ≥9% had more clinically significant declines. Insulin TDD decreased by -32, -38, and -42 units/day at 3, 6, and 12 months, respectively, where the mean decrease in insulin TDD at 12 months was 79 units/day among patients who discontinued bolus insulin (52.3%) compared with a mean decrease of 2 units/day among those who continued bolus insulin. Mean weight reductions at 3, 6, and 12 months were -1.2, -2.3, and -2.9 kg, respectively, from a mean baseline of 120.6 kg.
Combining a GLP-1-RA with basal-bolus insulin had a clinically significant improvement on blood glucose control, lowered insulin TDD, and reduced weight. These outcomes were achieved within 3 to 6 months following GLP-1-RA initiation and were maintained through 1 year.
2017 年，约有 740 万美国人使用胰岛素治疗糖尿病。胰岛素已被证明可降低 A1c，但会导致低血糖和体重增加。将胰岛素与胰高血糖素样肽-1 受体激动剂（GLP-1-RA）联合使用可能会提供额外的血糖控制，同时限制包括体重增加在内的不良影响。
描述在 2 型糖尿病患者中，将 GLP-1-RA 添加到基础-餐时胰岛素方案中的临床影响。
这项回顾性观察性研究使用了国家退伍军人健康管理局的数据，以确定在 2005 年 1 月 1 日至 2017 年 12 月 31 日期间开始使用 GLP-1-RA 的基础-餐时胰岛素方案的现有患者。在 GLP-1-RA 起始（基线）、3、6 和 12 个月时收集 A1c、胰岛素总日剂量（TDD）和体重，并采用最后观察值结转的意向治疗方法进行分析。A1c 下降≥0.5%和体重增加≥2kg 被认为具有临床意义。
在开始 GLP-1-RA 治疗的 7651 名患者中，A1c 在 3、6 和 12 个月时分别显著下降了 0.5%、0.7%和 0.7%，基线均值为 9%。基线 A1c 水平较低的患者 A1c 无显著变化，而基线 A1c≥9%的患者 A1c 下降更为显著。胰岛素 TDD 分别下降了-32、-38 和-42 单位/天，在 12 个月时，停止使用餐时胰岛素（52.3%）的患者胰岛素 TDD 的平均下降幅度为 79 单位/天，而继续使用餐时胰岛素的患者的平均下降幅度为 2 单位/天。在 3、6 和 12 个月时，体重分别平均减轻 1.2、2.3 和 2.9kg，基线平均体重为 120.6kg。
将 GLP-1-RA 与基础-餐时胰岛素联合使用可显著改善血糖控制，降低胰岛素 TDD，并减轻体重。这些结果在 GLP-1-RA 起始后 3 至 6 个月内达到，并在 1 年内保持。
