Diabetic medicine : a journal of the British Diabetic AssociationDec 13, 2023

Using mixed insulin with GLP-1 treatment compared to early basal insulin with GLP-1 in type 2 diabetes

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Mar 31, 2026

Abstract

In a cohort of 4,770 individuals with type 2 diabetes, glycated hemoglobin (HbA1c) reduction at 6 months was similar between those using biphasic insulin aspart 30/70 (BIAsp 30) plus a GLP-1 receptor agonist and those using basal insulin plus GLP-1RA.

The reduction in HbA1c was -1.07 %-points in the BIAsp 30 group and -0.97 %-points in the basal insulin group, with no significant difference (p = 0.15).
Body mass index (BMI) decreased by -0.35 kg in the BIAsp 30 group compared to -0.72 kg in the basal insulin group, with a significant difference (p = 0.003).
BMI changes were influenced by the order in which GLP-1RA and insulin were initiated (p < 0.0001).
Rates of hypoglycemia were low and not significantly different between the two treatment groups.

Simplified

AIMS: Combining insulin with a glucagon-like peptide-1 receptor agonist (GLP-1RA) to treat type 2 diabetes (T2D) is common. While many studies have investigated concomitant therapy with basal insulin+GLP-1RA, few have reported on premixed insulin+GLP-1RA. We aimed to address this gap using data from the Clinical Practice Research Datalink Aurum database in England.

METHODS: This retrospective cohort study with propensity score matching assessed glycaemic levels and other clinical outcomes in people with T2D, comparing biphasic insulin aspart 30/70 (BIAsp 30) + GLP-1RA with basal insulin (insulin detemir/glargine U100) + GLP-1RA (from 2006 to 2021).

RESULTS: In total, 4770 eligible people were identified; 1511 had a BIAsp 30 + GLP-1RA regimen and were propensity score-matched to an equal number receiving basal+GLP-1RA. There was no significant difference in glycated haemoglobin (HbA1c) reduction between cohorts at 6 months (p = 0.15), with a decrease of -1.07 (95% CI: -1.16; -0.98) %-points (-11.7 mmol/mol [95% CI: -12.7; -10.7]) in the BIAsp 30 + GLP-1RA cohort, versus -0.97 (95% CI: -1.07; -0.88) %-points (-10.6 mmol/mol [95% CI: -11.7; -9.6]) in the basal+GLP-1RA cohort. Body mass index (BMI) decreased by -0.35 kg/m(95% CI: -0.52;-0.18) at 6 months with BIAsp 30 + GLP-1RA, versus -0.72 kg/m(95% CI: -0.90;-0.54) with basal+GLP-1RA (p = 0.003). BMI was influenced by the initiation sequence of GLP-1RA in relation to insulin (p < 0.0001). Hypoglycaemia rates were low and not significantly different between cohorts. 2 2

CONCLUSIONS: Combining BIAsp 30 + GLP-1RA provides glycaemic control with no significant difference to that of propensity score-matched people receiving basal insulin+GLP-1RA, with no increase in hypoglycaemia risk or weight gain.

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Using mixed insulin with GLP-1 treatment compared to early basal insulin with GLP-1 in type 2 diabetes

Abstract

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