Comparison of adverse effects among different GLP-1 receptor agonists added to basal insulin, and between GLP-1 receptor agonists and basal insulin versus Basal-plus or basal-bolus insulin in type 2 diabetes: A meta-analysis
Internal Medicine Residency Program, Department of Internal Medicine, Sunrise Health GME Consortium, Mountain View Hospital, Las Vegas, Nevada, USA
Research Article
World Journal of Advanced Research and Reviews, 2021, 10(02), 119–134
Article DOI: 10.30574/wjarr.2021.10.2.0215
Publication history:
Received on 06 April 2021; revised on 08 May 2021; accepted on 11 May 2021
Abstract:
Diabetes mellitus type 2/ DM2/ - is increasing in incidence in United states and throughout the world mostly due to increasing Obesity epidemy- around 40 % of adult people in USA. Two are the major defects of the disease- insulin resistance which sets up the stage 4-7 years before DM type 2 is diagnosed and relative to the increased resistance insulin deficiency. After the diagnosis of DM type 2 the Insulin resistance stays usually constant while the Insulin deficiency progresses necessitating the intensification of the therapy and eventually the need of Insulin . Initially the insulin is started usually as a basal and eventually as the DM type 2- progresses we add bolus rapid acting insulin to major meal- basal plus regimen/BP/ and eventually to every meal- basal- bolus /BB/ insulin. This intensification of the therapy is frequently able to control DM type 2 , but leads to significant 3-4 kg weight gain with risk of hypoglycemia.
Other option of intensification of the therapy of DM type 2 is to add to the oral anti - diabetic medications only basal Insulin and GLP1- RAs. GLP1-RAs decrease post prandial blood sugar as the rapid acting insulin does and the long acting GLP1-RAs also decrease fasting blood sugar. GLP1- RAs suppress the appetite and theoretically might lead to weight loss and less incidence of hypoglycemia compare to BP/BB Insulin regimens, because they act on glucose dependent manner- increase the endogenous insulin production only if the blood sugar is elevated .
In our meta- analysis we concentrated our efforts into looking at the side effect of GLP 1- RAs and basal- Insulin combination compare to BP/BB insulin combination like weight loss/gain, incidence of hypoglycemia, adverse events- mainly the gastrointestinal ones.
Our secondary end point was the change in HbA1c between GLP1-RAs and basal insulin group compare to BP/BB insulin group in patients with HbA1c 7-11%.
This is the first meta- analysis as far as we now comparing those 2- combinations – BB/BP insulin to GLP1-RAs and basal insulin in the terms of looking as a primary end point at the side effects of those combinations.
Keywords:
Basal Insulin; Bolus Insulin; GLP1-Receptor agonists-GLP1-RAs; Diabetes Mellitus type 2-DM2; Hypoglycemia; Weight gain
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