Use of GLP-1 receptor agonists for type 2 diabetes treatment intensification after basal insulin failure

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are part of the armamentarium for the treatment of type 2 diabetes (T2D), although recent guidelines have mainly recommended their use on top of oral treatments when a single or combination of two or three oral hypoglycaemic agents has failed to lower HbA_1c levels below the individualized target range. In such situations, the decision to use GLP-1RAs is mostly driven by their high level of efficacy, their effect on body weight balance and their safety considerations, such as low hypoglycaemic risk. According to the current guidelines, GLP-1RAs may also be used in T2D patients in addition to basal insulin, following specialist-care advice, in patients who are more severely obese or who may not have the capacity to handle the complexities of a multiple daily injection (MDI) insulin regimen. The present review looks at the scientific evaluations performed in this context as well as the clinical trials assessing the use of GLP-1RAs in combination with intensive insulin therapy as further step-up therapy.