Related Experiment Video
Updated: May 8, 2026
09:31
Sustained Administration of β-cell Mitogens to Intact Mouse Islets Ex Vivo Using Biodegradable Poly(lactic-co-glycolic acid) Microspheres
Published on: November 5, 2016
The rationale for combining GLP-1 receptor agonists with basal insulin
Neale D Cohen1, Ralph Audehm, Elaine Pretorius
1Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia. neale.cohen@bakeridi.edu.au
The Medical Journal of Australia
|August 30, 2013
Summary
Combining basal insulin with glucagon-like peptide-1 (GLP-1) receptor agonists helps intensify type 2 diabetes treatment. This approach improves glucose control and reduces weight without increasing hypoglycemia risk.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Pharmacology
Background:
- Type 2 diabetes mellitus (T2DM) management is challenging due to the progressive nature of the disease.
- Intensifying treatment often increases risks of hypoglycemia and weight gain.
- Basal insulins effectively control fasting glucose but have limited impact on postprandial glucose excursions.
Purpose of the Study:
- To evaluate the efficacy and safety of combining glucagon-like peptide-1 (GLP-1) receptor agonists with basal insulin for T2DM treatment intensification.
- To assess the impact on glycemic control, weight, and hypoglycemia risk.
Main Methods:
- Prospective interventional trials were reviewed.
- Data on GLP-1 receptor agonists added to basal insulin therapy were analyzed.
Main Results:
- Combination therapy significantly decreased postprandial glucose levels and HbA1c.
- Patients experienced weight reduction and decreased basal insulin requirements.
- No increase in the risk of major hypoglycemic events was observed.
Conclusions:
- GLP-1 receptor agonists combined with basal insulin offer a viable strategy for intensifying T2DM therapy.
- This combination mitigates risks associated with intensified treatment, such as weight gain and hypoglycemia.
- Further research is needed on long-term effects and additional prandial regimens.
Related Concept Videos
01:24Glucagon-like Receptor Agonists
Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by the...
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by the...
01:06Oral Hypoglycemic Agents: Glinides
Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively manages...
01:23Dipeptidyl Peptidase 4 Inhibitors
Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a significant...
01:26Oral Hypoglycemic Agents: Biguanides and Glitazones
Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood glucose levels...
01:16Insulin: Dosing Regimen and Adverse Effects
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
01:16Hormones Regulating Blood Glucose
Insulin is released by beta cells of the pancreas when blood glucose levels are high. It facilitates glucose absorption and utilization in insulin-dependent cells with insulin receptors on their plasma membranes. Insulin promotes glucose uptake by increasing the number of glucose transport proteins in the cell membrane, allowing glucose to enter the cell. As a result, glucose utilization and ATP production are enhanced.
In addition to accelerating glucose uptake and utilization, insulin has...
In addition to accelerating glucose uptake and utilization, insulin has...