Avoiding insulin – GLP-1 receptor agonists can help control glucose levels

This study compared the effectiveness of albiglutide, a glucagon-like peptide-1 receptor agonist, with insulin glargine in type 2 diabetes mellitus.

Type 2 diabetes mellitus is a progressive disease, which means patients will need to alter or increase treatments over time. While type 2 diabetes is often initially treated with lifestyle changes in diet and exercise, eventually oral therapies to increase insulin production or sensitivity, such as metformin (Glucophage), or insulin therapy itself are needed. The first insulin generally used is a basal insulin, such as insulin glargine (Lantus), which is long-acting and injected once a day. However, this therapy is associated with weight gain and an increased risk of hypoglycemia (dangerously low blood glucose [sugar] levels).

Other glucose-lowering treatments include glucagon-like peptide-1 (GLP-1) receptor agonists, which stimulate insulin production and decrease glucose production. This treatment also does not contribute to weight gain. This study examined the effectiveness of albiglutide (Tanzeum), a GLP-1 receptor agonist, in comparison to insulin glargine as a treatment for type 2 diabetes.

This study compared 516 patients receiving albiglutide once a week and 263 receiving daily insulin glargine. All patients had uncontrolled blood glucose levels with metformin treatment alone. Participants were followed for 1 year, and HbA1c levels (a measure of average blood glucose over 3 months) from the beginning and end of the study were compared. Doses of both albiglutide and insulin glargine were allowed to increase over the study if needed to control blood glucose.

HbA1c decreased by 0.67% in the albiglutide group and 0.79% in the insulin glargine group; this difference was not statistically significant. 11% of the albiglutide group and 10.5% of the insulin glargine group met their HbA1c targets by the end of the study; this difference was also not statistically significant.

Hypoglycemia was experienced significantly more often in the insulin glargine patients (27.4%) than in the albiglutide patients (17.5%). Patients receiving insulin glargine gained an average of 3.5 pounds over the year of study, while patients receiving albiglutide lost an average of 2.3 pounds. A higher number of patients in the albiglutide group experienced adverse events needing treatment. The most common adverse event was nausea, experienced by 9.9% of those receiving albiglutide, compared to 3.7% receiving insulin glargine.

This study concluded that the glucagon-like peptide-1 (GLP-1) receptor agonist albiglutide (Tanzeum) was not inferior to insulin glargine (Lantus) as a treatment for type 2 diabetes patients whose blood glucose was uncontrolled with metformin (Glucophage) alone.