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Insulin Dosage Adjustments After Initiation of GLP-1 Receptor Agonists in Patients With Type 2 Diabetes

Mandy Chen1,2, Etty Vider1,3, Roda Plakogiannis1,2

  • 12045Long Island University, Arnold and Marie Schwartz College of Pharmacy, Brooklyn, NY, USA.

Journal of Pharmacy Practice
|February 17, 2021
PubMed
Abstract

Insights

Initiating glucagon-like peptide-1 receptor agonists (GLP-1RAs) with insulin therapy significantly reduced basal insulin doses in patients with type 2 diabetes. This suggests a potential need for dose adjustments when starting GLP-1RAs.

Area of Science:

  • Endocrinology
  • Pharmacology
  • Diabetes Management

Background:

  • Combination therapy of insulin and GLP-1RAs demonstrates benefits in HbA1c, weight, and hypoglycemia risk.
  • Conflicting data exists on the impact of GLP-1RAs on insulin dosage requirements.

Purpose of the Study:

  • To evaluate the necessary adjustments in insulin doses when initiating GLP-1RAs in patients with type 2 diabetes.
  • To analyze changes in various insulin types and related metabolic parameters.

Main Methods:

  • Retrospective chart review of 45 patients with type 2 diabetes on insulin therapy who started GLP-1RAs.
  • Primary endpoint: median change in overall basal insulin dose. Secondary endpoints: changes in insulin doses, HbA1c, body weight, and glucose levels.
  • Safety assessment for adverse reactions to insulin and GLP-1RA.

Main Results:

  • A statistically significant reduction in overall total basal insulin doses was observed from baseline to 24 weeks (50 units vs. 44 units).
  • Median reductions in basal insulin doses were noted for glargine (50 to 44 units) and detemir (29 to 21.5 units).

Conclusions:

  • GLP-1RA use led to a significant reduction in total basal insulin dosages after 24 weeks.
  • Consider a ≥10% reduction in basal insulin dose upon initiating GLP-1RAs for patients with HbA1c >8%.
Keywords:
ambulatory careendocrinologyinternal medicine

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