What next? When basal insulin and oral anti-diabetic medication doesn’t control blood glucose.

This study compared additional treatment options for patients with uncontrolled type 2 diabetes (T2D) currently taking basal insulin and other oral anti-diabetic drugs (OADs). They concluded that lixisenatide (Lyxumia and Adlyxin) may be a preferable option to insulin with meals. 

One treatment option for T2D is a combination of OADs plus basal insulin (maintains steady supply of insulin throughout the day). However, some patients may still find their diabetes to be uncontrolled. Typically, these patients will begin to take fast-acting insulin with each meal. Although this improves blood glucose control, patients tend to experience weight gain and more hypoglycemia (low blood sugar which may cause dizziness, confusion or loss of consciousness).

GLP-1 agonists (glucagon-like peptide) such as lixisenatide may be a new alternative. They do not increase risk of low blood sugar or weight gain. Lixisenatide triggers insulin production and lowers hormones which increase blood glucose. The addition of lixisenatide has not yet been directly compared to the addition of fast-acting insulin.

This study included 894 patients with uncontrolled T2D, treated with the basal insulin glargine (Lantus) and other OADs. Patients were divided into 3 groups. One group received lixisenatide once a day, while the other two groups received insulin glulisine (Apidra), a fast acting insulin, once or three times a day.

Lixisenatide and insulin glulisine equally improved blood glucose control. There were no significant differences between the groups.

Lixisenatide resulted in average weight loss of 0.6 kg in 26 weeks. Insulin glulisine resulted in average weight gain of 1kg in the once daily group and 1.4kg in the three times daily group.

Lixisenatide was more effective at normalizing blood glucose levels 2 hours after a meal compared to insulin glulisine. Lixisenatide patients were 25% less likely to experience low blood sugar compared to the once daily insulin glulisine group and 51% less likely compared to the 3 times daily insulin glulisine group.

Lixisenatide was twice as likely improve blood glucose control without weight gain or low blood sugar. However, lixisenatide was more likely to cause gastrointestinal (stomach and bowel) side effects. 

This study concluded that all three treatment options improve blood glucose control in patients with longstanding diabetes currently taking basal insulin and other OADs. However, lixisenatide is associated with reduced body weight and fewer periods of low blood sugar.

This trial was funded by Sanofi, the manufacturers of lixisenatide.