Insulin injections plus GLP-1 RAs may improve A1c, reduce insulin dose in diabetic patients

Use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in combination with multiple daily insulin injections (MDII) is associated with an improvement in A1c and a reduction in insulin doses without increased hypoglycaemia, reports a study.

“Guidelines do not offer recommendations regarding the use of GLP-1 RAs in combination with MDII regimens,” the authors said. “This review evaluates current studies demonstrating efficacy and safety considerations of this combination.”

A literature search was conducted in the databases of Medline and Embase from 2004 to May 2020 using the terms glucagon-like 1 receptor agonist, liraglutide, albiglutide, dulaglutide, exenatide, semaglutide, diabetes mellitus, and prandial insulin or bolus insulin. The authors obtained additional references from cross-referencing and bibliographies of selected studies.

Eight studies met the eligibility criteria. MDIIs plus GLP-1 RA correlated with a decrease in A1c in seven out of eight studies, and with weight loss in five studies. In studies that adjusted insulin following the addition of GLP-1 RAs, three studies reported a reduction in average total daily insulin dose.

Notably, hypoglycaemia frequency and other adverse events did not increase with the addition of GLP-1 RAs to MDII.

“While some studies did demonstrate an improvement in A1c and reduction in insulin doses without increased hypoglycaemia, larger randomized controlled trials are needed to adequately assess the benefit and safety of GLP-1 RAs in combination with MDII,” the authors said.