Adding GLP-1 Receptor Agonist Therapy to Basal Insulin for Postprandial Glucose Control

E ven with current guidelines, treatment algorithms, and recommendations available regarding diabetes management (1,2), providers struggle with adding therapies to manage postprandial hyper-glycemia after basal insulin therapy in combination with oral antidia-betic medications (OADs) has failed to control a patient's hyperglycemia. Historically, after titration of basal insulin to achieve morning glucose control, adding a bolus, or prandial, rapid-acting insulin analog has been recommended either in a stepwise approach or as a full basal-bolus insulin regimen (3–5). However, recent research has shown that adding a GLP-1 receptor agonist to basal insulin may be as effective as adding prandial insulin therapy (6–8). These results have given providers and patients a potentially easier option when glycemic control is not achieved with basal insulin in combination with OADs. This article summarizes three recent articles demonstrating the glycemic control efficacy and other benefits of adding a GLP-1 receptor agonist to basal insulin and describes a strategy to implement this therapy in busy primary care settings. Study Group. Advancing basal insulin replacement in type 2 diabetes inadequately controlled with insulin glargine plus oral agents: a comparison of adding albiglutide, a weekly GLP-1 receptor agonist, versus thrice-daily prandial insulin lispro. Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis. Group. Glucagon-like peptide 1 receptor agonist or bolus insulin with optimized basal insulin in type 2 diabetes. Summary Article A reported on a randomized, open-label, active-controlled trial testing once-weekly albiglutide versus thrice-daily prandial insulin lis-pro as an add-on to titrated insulin glargine. The primary endpoint of the study was A1C change from baseline to 26 weeks. Albiglutide was found to be noninferior based on predefined endpoints but numerically superior to lispro as part of a basal-bolus insulin regimen, with A1C reductions of 0.82 and 0.66%, respectively. The albiglutide treatment group had a mean weight loss of 0.73 kg with no severe hypoglycemia and 15.8% rate of documented hypoglycemia. The lis-pro group had a mean 0.81 kg weight gain, two episodes of severe hypogly-cemia, and a 29.9% rate of documented hypoglycemia. However, gastroin-©2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http:// creativecommons.org/licenses/by-nc-nd/3.0 for details.