Impact of a Weekly Glucagon-Like Peptide 1 Receptor Agonist, Albiglutide, on Glycemic Control and on Reducing Prandial Insulin Use in Type 2 Diabetes Inadequately Controlled on Multiple Insulin Therapy: A Randomized Trial

Jul 23, 2020Diabetes care

Weekly Albiglutide and its effects on blood sugar control and mealtime insulin use in type 2 diabetes not controlled by multiple insulin injections

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Abstract

In a study involving 814 participants, 54% successfully replaced prandial insulin with a weekly glucagon-like peptide 1 receptor agonist (GLP-1RA).

Glycemic control improved in both treatment groups, with HbA1c levels reducing to 6.7% in the albiglutide + glargine group and 6.6% in the lispro + glargine group at week 26.
The albiglutide + glargine group experienced a reduction in total daily prandial insulin dose by 62 units/day.
The number of weekly injections decreased from 29 to 13 in the albiglutide + glargine group.
Participants on albiglutide + glargine had fewer severe/documented symptomatic hypoglycemia events (57.2% vs. 75.0%).
Weight loss was observed in the albiglutide + glargine group (-2.0 kg) compared to weight gain in the lispro + glargine group (+2.4 kg).
Gastrointestinal adverse events were more common in the albiglutide + glargine group (26% vs. 13%).

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OBJECTIVE: The principle of replacing prandial insulin lispro with a once-weekly glucagon-like peptide 1 receptor agonist (GLP-1RA) for type 2 diabetes inadequately controlled on a multiple daily insulin injections regimen was tested with albiglutide.

RESEARCH DESIGN AND METHODS: In this treat-to-target study, basal plus prandial insulin was optimized over 4 weeks before participants were randomized (1:1) to albiglutide plus optimized basal insulin glargine and lispro (dose reduced by 50% at randomization; subsequently, lispro injections were fully discontinued 4 weeks later) (= 402) or to continued optimized lispro plus optimized glargine (= 412). n n

RESULTS: Mean ± SD HbAat baseline, 7.8 ± 0.6% (61 ± 7 mmol/mol) in the albiglutide + glargine group and 7.7 ± 0.6% (60 ± 7 mmol/mol) in the lispro + glargine group, was reduced at week 26 to 6.7 ± 0.8% (49 ± 8 mmol/mol) and 6.6 ± 0.8% (48 ± 8 mmol/mol), respectively (least squares [LS] difference 0.06% [95% CI -0.05 to 0.17]; noninferiority< 0.0001). In the albiglutide + glargine group, 218 participants (54%) replaced all prandial insulin without reintroducing lispro up to week 26. Total daily prandial insulin dose was similar at baseline but was lower by 62 units/day (95% CI -65.9 to -57.8;< 0.0001) at week 26 in the albiglutide + glargine group, and the total number of weekly injections was also reduced from 29 to 13 per week. Less severe/documented symptomatic hypoglycemia (57.2% vs. 75.0%) occurred in the albiglutide + glargine group with meaningful weight differences (LS mean ± SE -2.0 ± 0.2 vs. +2.4 ± 0.2 kg;< 0.0001) vs. lispro + glargine. Gastrointestinal adverse events were higher with albiglutide + glargine (26% vs. 13%). 1c P P P

CONCLUSIONS: A once-weekly GLP-1RA was able to substitute for prandial insulin in 54% of people, substantially reducing the number of prandial insulin injections; glycemic control improved, with the added benefits of weight loss and less hypoglycemia in the GLP-1RA arm. Replacing prandial insulin with a weekly GLP-1RA can simplify basal plus prandial insulin treatments and achieve better outcomes in type 2 diabetes.

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Impact of a Weekly Glucagon-Like Peptide 1 Receptor Agonist, Albiglutide, on Glycemic Control and on Reducing Prandial Insulin Use in Type 2 Diabetes Inadequately Controlled on Multiple Insulin Therapy: A Randomized Trial

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