In a nutshell
This review analyzed the effects of incretin based therapies in combination with insulin as treatment for uncontrolled type 2 diabetes mellitus (T2DM).
Some background
Non-insulin oral drugs, such as incretin based therapies, are a common treatment for T2DM patients. Incretins are hormones that are normally released by the body in response to high blood glucose levels. Incretin hormones, such as glucagon-like peptide (GLP-1), reduce the release of glucose into the blood and increase the release of insulin. Therefore, GLP-1 plays a major role in reducing blood glucose levels after meals. Two classes of drugs are based on the normal function of incretins. GLP-1 analogs, such as exenatide (Byetta) or liraglutide (Victoza), mimic the function of GLP-1. DDP-4 inhibitors, such as sitagliptin (Januvia) or vildagliptin (Galvus), block the action of the enzyme dipeptidyl peptidase 4, which normally brakes down GLP-1.
When T2DM is uncontrolled with the use of non-insulin oral drugs, basal insulin can be used to reduce blood glucose levels. Some non-insulin drugs, such as metformin (Glucophage), are commonly continued along side insulin treatment. However, few studies have investigated the combination of incretin based therapies with basal insulin. This combination of drugs is appealing in theory, since insulin mainly affects fasting blood glucose levels (glucose levels in between meals), while incretin based therapies mainly affect postprandial blood glucose levels (glucose levels after a meal).
Methods & findings
In one of the controlled trials analyzed in this review, 261 T2DM patients treated with basal insulin were assigned to receive either exenatide or a placebo in addition to insulin. The use of exenatide in addition to insulin was associated with a reduction in HgbA1c values (a measurement of average blood glucose levels over the past 3 months) of 1.74%. Patients receiving exenatide in addition to basal insulin required lower doses of insulin, and the number of hypoglycemic events (dangerously low blood glucose levels) were also significantly reduced.
In a similar trial analyzed in this review, 296 T2DM patients treated with basal insulin were assigned to receive either vildagliptin or a placebo in addition to insulin. The use of vildagliptin in addition to insulin was associated with a reduction in HgbA1c values of 0.5%.
The bottom line
This review concluded that the combination of incretin based therapies with basal insulin is effective in reducing blood glucose levels and in preventing hypoglycemic events.
What’s next?
Consult with your physician regarding the combination of incretin based therapies with insulin in the management of uncontrolled diabetes.
Published By :
Diabetes & Metabolism
Date :
Sep 27, 2012
