Free and fixed‐ratio combinations of basal insulin and GLP‐1 receptor agonists versus basal insulin intensification in type 2 diabetes: A systematic review and meta‐analysis of randomized controlled trials. Issue 9 (24th May 2018)

• Record Type: Journal Article
• Authors: Maiorino, Maria Ida; Chiodini, Paolo; Bellastella, Giuseppe; Scappaticcio, Lorenzo; Longo, Miriam; Esposito, Katherine; Giugliano, Dario
• Is Part Of: Diabetes, obesity & metabolism. Volume 20:Issue 9(2018)
• Page Start: 2309
• Page End: 2313
• Publication Date: 2018-05-24
• Subjects: basal insulin and GLP‐1RA -- combination therapy -- free or fixed combination -- meta‐analysis -- type 2 diabetes mellitus; Diabetes -- Periodicals; Obesity -- Periodicals; Metabolism -- Disorders -- Periodicals; Clinical pharmacology -- Periodicals; 616.462
• DOI: 10.1111/dom.13343
• Languages: English
• ISSNs: 1462-8902

Abstract

Abstract : A meta‐analysis is presented of randomized controlled trials (RCTs) comparing free or fixed combinations of a glucagon‐like peptide‐1 receptor agonist plus basal insulin versus insulin intensification on metabolic control in patients with type 2 diabetes. Electronic databases were searched for RCTs assessing changes in HbA1c, proportion of patients at HbA1c target of <7% (53 mmol/mol), hypoglycaemia and body weight. A random‐effect model was used to calculate the weighted mean difference (WMD) or relative risk (RR) with 95% CI. Eleven RCTs were identified, lasting 24–30 weeks and involving 6176 patients. In the overall analysis, the combination therapy led to a mean HbA1c decrease significantly greater than insulin up‐titration (WMD −0.53%, 95% CI, −0.66, −0.40%, P < 0.001), more patients at HbA1c target (RR 1.69, 95% CI, 1.42, 2.00, P < 0.001), similar hypoglycaemic events (RR 0.97, 95% CI, 0.84, 1.12, P = 0.114), and reduction in body weight (WMD −1.9, 95% CI −2.3, −1.4, P < 0.001), with heterogeneity (I 2 > 71%, P < 0.001). Results did not differ in either the free or fixed combination subgroups. Combination strategies, either free or fixed, represent a good option for intensifying basal insulin therapy in patients with type 2 diabetes who need amelioration of glycaemic control.