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Homogeneous Time-resolved Förster Resonance Energy Transfer-based Assay for Detection of Insulin Secretion
Published on: May 10, 2018
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Is insulin the most effective injectable antihyperglycaemic therapy?
J B Buse1, A Peters, D Russell-Jones
1University of North Carolina School of Medicine, Medicine/Endocrinology, Chapel Hill, NC, USA.
Diabetes, Obesity & Metabolism
|October 18, 2014
Summary
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) like exenatide and liraglutide offer comparable or superior HbA1c reduction versus insulin glargine in type 2 diabetes. These GLP-1RAs are effective even with very high baseline HbA1c levels.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Pharmacology
Background:
- Recent guidelines suggest insulin for high HbA1c in type 2 diabetes.
- Randomized studies showed GLP-1RAs (exenatide OW, liraglutide OD) achieved greater HbA1c reduction than insulin glargine.
- Baseline HbA1c was approximately 8.3% in prior comparative trials.
Purpose of the Study:
- To analyze HbA1c, fasting glucose, and weight changes in type 2 diabetes patients treated with exenatide once-weekly or liraglutide once-daily versus insulin glargine.
- To evaluate treatment efficacy across different baseline HbA1c levels (quartiles).
Main Methods:
- Post hoc analysis of DURATION-3 and LEAD-5 trials.
- Descriptive statistics for HbA1c, fasting glucose, weight, and insulin dose changes.
- ANCOVA model used to assess HbA1c change similarity across baseline HbA1c quartiles.
Main Results:
- HbA1c reduction and achieving HbA1c <7.0% were similar or greater with GLP-1RAs than glargine across all baseline HbA1c quartiles.
- Fasting glucose reduction was similar or greater with glargine.
- GLP-1RAs led to weight loss, while glargine caused weight gain, more pronounced at higher baseline HbA1c.
- Gastrointestinal events were more frequent with GLP-1RAs.
Conclusions:
- GLP-1RAs provide at least equivalent HbA1c reduction compared to basal insulin (glargine), regardless of baseline HbA1c.
- Liraglutide and exenatide once-weekly are viable alternatives to basal insulin for type 2 diabetes, including cases with very high baseline HbA1c (≥9.0%).
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