Efficacy and safety of basal-bolus insulin vs glp-1 receptor agonist plus basal insulin in patients with uncontrolled type 2 diabetes

This article compared the safety and effectiveness of insulin detemir (Levemir) plus liraglutide (Victoza) vs insulin detemir plus insulin aspart (Novolog) in the management of type 2 diabetes (T2D). The authors concluded that detemir plus liraglutide is a safe and more effective treatment option for patients with T2D.  

In T2D the body does not use insulin properly and cannot lower the blood glucose. If blood glucose-lowering drugs are ineffective, patients have to get insulin from an injection in order to lower blood glucose. Detemir is a long-acting form of insulin which lowers the blood glucose during the day. It is usually taken in combination with aspart (a fast-acting form of insulin) after meals. However, this therapy has certain side effects including weight gain and hypoglycemia (dangerously low blood glucose).

An alternative is to combine liraglutide with detemir. Liraglutide is a glucagon-like peptide-1 receptor agonist (GLP1RA). It increases insulin secretion in the body and it is known to have fewer side effects compared with insulin alone. Measuring HbA1c (blood glucose control over the past 3 months) allows saying how well diabetes is controlled. It is not known in detemir plus liraglutide (DE-LI) is safe and effective as detemir plus aspart (DE-AS) in patients with uncontrolled T2D.

This study involved 120 patients with T2D for approximately 10 years. All patients had HbA1c levels of 10% or higher. They were randomly assigned to two groups. Group 1 received DE-LI. Group 2 received DE-AS. The study lasted for 6 months. 

At the end of the 6 months, HbA1c decreased from 12.2% to 8.1% in group 1, and from 11.8% to 8.8% in group 2. Group 1 had a decrease of 3.7 kg in body weight and an improvement in the quality of life (QOL). Patients in group 1 also had fewer hypoglycemia episodes (66.5%) compared with 35.2% in group 2. 

The authors concluded that detemir plus liraglutide is a safe and effective treatment option for patients with T2D and HbA1c of 10% and higher. 

This study had a short follow up period of 6 months carried out in only one center. Longer-term studies with a larger population would be needed to confirm the results.