Use of fixed-ratio combination of basal insulin and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in Asians...

People with type 2 diabetes in Asia have heterogeneous phenotypes but share common features of young age-at-diagnosis, low body mass index, low pancreatic beta-cell capacity, rapid decline in insulin secretion as well as visceral and ectopic fat excess. Cardiovascular diseases are the leading causes of mortality in people with diabetes. In clinical trial settings, despite receiving protocol-driven care, Asians had higher risk of chronic kidney disease than non-Asians. Aging and improved survival in people with diabetes continue to drive the epidemic of diabetes. People with old age, long disease duration and complications might benefit from both insulin to optimize glucose control and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for cardiovascular-renal protection. Complex therapies pose challenges in administration and adherence where fixed-dose combination such as basal insulin plus GLP-1 RA may improve safety, effectiveness and acceptability. In this narrative review, we summarized the efficacy and safety data from randomized controlled trials using iGlarLixi, a fixed-ratio combination of insulin glargine 100 U/mL (iGlar) and lixisenatide (Lixi), a short acting GLP-1 RA, studied widely in Asians. We discussed the guidelines on the use of this fixed-ratio combination illustrated by real-world case studies in older Asian adults with young-onset type 2 diabetes.