Does combining insulin glargine with lixisenatide lead to better outcomes?

This study compared the effectiveness and safety of a combination of insulin glargine (Lantus) and lixisenatide (Lyxumia), called iGlarLixi, to either drug on its own, in people with type 2 diabetes (T2D). It was determined that iGlarLixi was more effective in reducing HbA1c, and did not increase the risk of side effects.

Insulin is the hormone that lowers blood glucose. Insulin glargine is an altered form of normal insulin that is injected once a day to provide a steady supply of insulin to the body. Lixisenatide is a GLP1RA that is injected once a day. GLP1RAs help to stimulate the release of insulin, and inhibit the release of glucagon (hormone that raises blood glucose). iGlarLixi combines the two drugs in a single injection. Combining insulin glargine and lixisenatide may lead to better control of blood glucose levels. Furthermore, GLP1RAs can reduce weight gain, which is a side effect of insulin.

This study examined data from two different studies. 1,898 people with T2D participated. They were randomly divided into 3 groups. Group 1 received iGlarLixi. Group 2 received insulin glargine. Group 3 received lixisenatide. They were followed for 30 weeks. The participants in all groups were classified as low-risk (LR) if they were younger than 65 and did not have other health problems. If they were older than 65, or had other health issues, they were classified as high-risk (HR). The LR participants were given an HbA1c goal (average blood glucose over the last 3 months) of under 7%, and the HR participants were given a goal of under 8%.

HbA1c was reduced in all groups. Reductions in HbA1c were greater in group 1 (1.1%-1.6%) than in the other two groups. HbA1c was reduced by 0.6%-1.3% in group 2, and by 0.8-0.9% in group 3. Reductions in HbA1c were similar in HR and LR participants. Group 1 was more likely to achieve their HbA1c goal than the other 2 groups.

Fasting blood glucose (FBG; blood glucose levels after a period without food or drink) and post-prandial blood glucose (PBG; blood glucose levels after a meal) were reduced in all groups. PBG reductions were greater in group 1 than in group 2. PBG reductions were similar in HR and LR participants. FBG was reduced a similar amount in groups 1 and 2, but fell more in group 1 than in group 3.

Hypoglycemia (dangerously low blood glucose) occurred at a similar rate in groups 1 and 2. Hypoglycemia was less likely in group 3. Rates of hypoglycemia were similar in LR and HR participants. LR participants in group 1 did not experience a change in weight, while HR participants in group 1 experienced a slight weight loss (0.8-1kg). LR and HR participants in group 2 experienced weight gain, with a slightly higher weight gain in HR participants. LR and HR participants in group 3 had a greater weight loss than group 1.

The study concluded that, regardless of a patient’s health risks, iGlarLixi is more effective than insulin glargine or lixisenatide in controlling blood glucose, without increasing the risk of hypoglycemia and without causing weight gain.

This study was funded by the manufacturers of iGlarLixi.

Discuss the risks and benefits of combining GLP1RAs and insulin with your physician.