Titration of Basal and Prandial Insulin Doses With the Initiation of Glucagon-Like Peptide-1 Receptor Agonist Therapy

TL;DR

This study found that starting GLP-1 RA therapy in type 2 diabetes patients led to significant improvements in blood sugar control and weight loss, with a trend toward reduced insulin use.

Contribution

The study provides real-world evidence on insulin dose adjustments when initiating GLP-1 RA therapy in type 2 diabetes patients.

Findings

Average hemoglobin A1c decreased significantly from 8.8% to 8.0% after three months of GLP-1 RA therapy.

Patients experienced significant reductions in body weight, LDL cholesterol, and total cholesterol.

Basal and prandial insulin doses decreased, but the changes were not statistically significant.

Abstract

Objective

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated significant efficacy in improving glycemic control in type 2 diabetes mellitus, which often results in decreased insulin dose requirements. The purpose of this study was to examine the changes in basal and prandial insulin dose requirements from baseline to three months following initiation of a GLP-1 RA.

Methodology

A retrospective chart review was conducted of adult insulin-treated patients at the Chertow Diabetes Center, Huntington, WV, who were started on GLP-1 RAs for 24 months.

Results

Mean daily basal insulin doses decreased by 8.7 units (P = 0.29; mean 8.3% change) and mean daily prandial insulin doses decreased by 9.4 units (P = 0.10; mean 18.4% change) from baseline to three months after starting a GLP-1 RA. Average hemoglobin A1c significantly decreased from 8.8% (73 mmol/mol) at baseline to 8.0% (64 mmol/mol) at three months (P < 0.001). Significant decreases from baseline to three months were also observed in mean body weight, mean low-density lipoprotein (LDL) cholesterol, and mean total cholesterol.

Conclusions

GLP-1 RA therapy was associated with a significant decrease in hemoglobin A1c, body weight, and LDL-cholesterol from baseline to three months after initiation. Therapy with GLP-1 RAs was also associated with an overall decrease in daily basal and prandial insulin dose requirements, although this finding did not reach statistical significance.