TY - JOUR
T1 - Incretin-based therapy in combination with basal insulin
T2 - A promising tactic for the treatment of type 2 diabetes
AU - Vora, J.
AU - Bain, S. C.
AU - Damci, T.
AU - Dzida, G.
AU - Hollander, P.
AU - Meneghini, L. F.
AU - Ross, S. A.
N1 - Funding Information:
J.V. has received support for research and attendance at national and international educational meetings, and honoraria for lecturing and sitting on advisory boards from Novo Nordisk, Eli Lilly, Sanofi Aventis, MSD Takeda, Novartis, Boehringer Ingelheim and Abbott Laboratories. S.C.B. reports having received lecture fees and research, educational and clinical grants from Boehringer Ingelheim, Diartis Pharmaceuticals, Eli Lilly, GlaxoSmithKline, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, Sanofi Aventis, Schering-Plough, Servier and Takeda. T.D. has received consulting fees from AstraZeneca, Novo Nordisk and Sanofi Aventis. G.D. consults for LifeScan and Novo Nordisk, and has received lecture fees from Bioton, Eli Lilly, Novo Nordisk, Sanofi Aventis and Servier. L.F.M. has received consulting fees from Novo Nordisk and Sanofi Aventis, and has received grants or has grants pending with Boehringer Ingelheim, MannKind, Medtronic, Novo Nordisk and Pfizer. P.H. has consulted for Novo Nordisk. S.A.R. has received research funding and/or honoraria from Novo Nordisk, Eli Lilly, MSD, Boehringer Ingelheim, Sanofi Aventis and Bristol-Myers Squibb.
PY - 2013
Y1 - 2013
N2 - Incretin therapies such as dipeptidyl peptidase-4 inhibitors (DPP-4Is) and GLP-1 receptor agonists (GLP-1RAs) have become well-established treatments for type 2 diabetes. Both drug classes reduce blood glucose through physiological pathways mediated by the GLP-1 receptor, resulting in glucose-dependent enhancement of residual insulin secretion and inhibition of glucagon secretion. In addition, the GLP-1RAs reduce gastrointestinal motility and appear to have appetite-suppressing actions and, so, are often able to produce clinically useful weight loss. The glucose-dependency of their glucagon-inhibiting and insulin-enhancing effects, together with their weight-sparing properties, make the incretin therapies a logical proposition for use in combination with exogenous basal insulin therapy. This combination offers the prospect of an additive or synergistic glucose-lowering effect without a greatly elevated risk of hypoglycaemia compared with insulin monotherapy, and any insulin-associated weight gain might also be mitigated. Furthermore, the incretin therapies can be combined with metformin, which is usually continued when basal insulin is introduced in type 2 diabetes. Although the combination of incretin and insulin therapy is currently not addressed in internationally recognized treatment guidelines, several clinical studies have assessed its use. The data, summarized in this review, are encouraging and show that glycaemic control is improved and weight gain is limited or reversed (especially with the combined use of GLP-1RAs and basal insulin), and that the use of an incretin therapy can also greatly reduce insulin dose requirements. The addition of basal insulin to established incretin therapy is straightforward, but insulin dose adjustment (though not discontinuation) is usually necessary if the sequence is reversed.
AB - Incretin therapies such as dipeptidyl peptidase-4 inhibitors (DPP-4Is) and GLP-1 receptor agonists (GLP-1RAs) have become well-established treatments for type 2 diabetes. Both drug classes reduce blood glucose through physiological pathways mediated by the GLP-1 receptor, resulting in glucose-dependent enhancement of residual insulin secretion and inhibition of glucagon secretion. In addition, the GLP-1RAs reduce gastrointestinal motility and appear to have appetite-suppressing actions and, so, are often able to produce clinically useful weight loss. The glucose-dependency of their glucagon-inhibiting and insulin-enhancing effects, together with their weight-sparing properties, make the incretin therapies a logical proposition for use in combination with exogenous basal insulin therapy. This combination offers the prospect of an additive or synergistic glucose-lowering effect without a greatly elevated risk of hypoglycaemia compared with insulin monotherapy, and any insulin-associated weight gain might also be mitigated. Furthermore, the incretin therapies can be combined with metformin, which is usually continued when basal insulin is introduced in type 2 diabetes. Although the combination of incretin and insulin therapy is currently not addressed in internationally recognized treatment guidelines, several clinical studies have assessed its use. The data, summarized in this review, are encouraging and show that glycaemic control is improved and weight gain is limited or reversed (especially with the combined use of GLP-1RAs and basal insulin), and that the use of an incretin therapy can also greatly reduce insulin dose requirements. The addition of basal insulin to established incretin therapy is straightforward, but insulin dose adjustment (though not discontinuation) is usually necessary if the sequence is reversed.
KW - DPP-IV inhibitors
KW - GLP-1 analogue
KW - HbA
KW - Insulin
KW - Review
KW - Type 2 diabetes mellitus
KW - Weight
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U2 - 10.1016/j.diabet.2012.08.002
DO - 10.1016/j.diabet.2012.08.002
M3 - Review article
C2 - 23022130
AN - SCOPUS:84874288415
SN - 1262-3636
VL - 39
SP - 6
EP - 15
JO - Diabetes and Metabolism
JF - Diabetes and Metabolism
IS - 1
ER -