A once-weekly glucagon-like peptide 1 receptor agonist (GLP-1RA) was able to substitute prandial insulin in some individuals, according to results of a treat-to-target study published in Diabetes Care.
Though insulin injections remain the cornerstone therapy for longer-duration type 2 diabetes (T2D), insulin regimens can be difficult to manage and are often not adhered to. Less complex therapeutic approaches, such as the use of GLP-1RAs, may improve adherence as well as eliminate unwanted side-effects observed in insulin use. Albiglutide is a GLP-1RA that has been shown to improve glycemic control in individuals with T2D in conjunction with diet and exercise.
To determine if once-weekly GLP-1RA could effectively treat individuals with T2D, whose diabetes were inadequately controlled by multiple daily prandial insulin lispro injections, 814 individuals with T2D were enrolled in a treat-to-target, randomized clinical trial (ClinicalTrials.gov Identifier: NCT02229227). Included participants were experiencing inadequate glycemic control (glycated hemoglobin [HbA1c] ≥ 7.0% to ≤ 9.5%) on a basal plus prandial insulin regimen. The mean duration of diabetes was 15 years and the mean HbA1c at baseline was 7.7% in both groups. Basal plus prandial insulin glargine and lispro was optimized over 4 weeks and served as the active control treatment. Individuals were randomly assigned in equal proportion to receive either the active control or the active control plus a once weekly dose of albiglutide and a 50% reduction in lispro for 26 weeks.
The primary efficacy endpoint was the change in HbA1C at 26 weeks. The proportion of participants that achieved HbA1c < 7.0% was similar between groups. In the albiglutide + glargine group, 54% of participants were able to completely replace lispro with albiglutide through week 26. Total insulin dose decreased in the albiglutide group and increased in the control group. Incidence of hypoglycemia was significantly greater in the control group than the albiglutide group (odds ratio [OR], 0.43; 95% CI, 0.31-0.60).
Limitations of this study include its duration of 26 weeks, which may not encompass the long-term effects of transitioning from traditional insulin to GLP-1RA. Further investigation into the long-term effects of albiglutide as well as the efficacy of other GLP-1RAs is warranted.
Disclosure: The NCT02229227 clinical trial was funded by GlaxoSmithKline. Please refer to original reference for a full list of author disclosures.
Rosenstock J, Nino A, Soffer J, et al. Impact of a weekly glucagon-like peptide 1 receptor agonist, albiglutide, on glycemic control and on reducing prandial insulin use in type 2 diabetes inadequately controlled on multiple insulin therapy: A randomized trial. Published online July 21, 2020. Diabetes Care. doi:10.2337/dc19-2316