Adjusting background insulin therapy in type 2 diabetes when initiating a glucagon-like peptide 1 receptor agonist: A case series
Abstract
Introduction: Guidelines recommend preferential use of antihyperglycemic medications with proven cardiovascular benefit for the treatment of patients with type 2 diabetes with established atherosclerotic cardiovascular disease (ASCVD), high risk factors for ASCVD, kidney disease, or heart failure. However, current guidelines offer little to no practical recommendations for adding these therapies to a patient’s current regimen while avoiding hyperglycemia or hypoglycemia. Nevertheless, considering background therapy in a proactive effort to avoid undesirable glycemic excursions when initiating any new antidiabetic medication remains paramount.
Case Series: A six-patient case series investigates adjustments to background therapies and glycemic outcomes surrounding the initiation and titration of long-acting glucagon-like peptide 1 receptor agonists (GLP-1 RAs) to shed light on practical methods to manage patient care during this tenuous phase. Overarching findings regarding background therapy adjustments to avoid hypoglycemia when initiating a GLP-1 RA include: (1) safe continuation of metformin regardless of baseline A1C or concurrent glycemic background therapy; (2) continuation of background therapy when the baseline A1C is above 9%; (3) consideration of a proactive 15–20% basal insulin dose reduction when the baseline A1C is below 7.5%; (4) proactive bolus insulin dose reduction by 25% or complete discontinuation at the time of GLP-1 RA initiation.
Conclusion: No dose…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- The Role of AMPK Activation for Cardioprotection in Doxorubicin-Induced Cardiotoxicity
- Hypoglycemic medicines in the treatment of Alzheimer’s disease: Pathophysiological links between AD and glucose metabolism
- Isorhamnetin Reduces Glucose Level, Inflammation, and Oxidative Stress in High-Fat Diet/Streptozotocin Diabetic Mice Model
- Modulating Sirtuin Biology and Nicotinamide Adenine Diphosphate Metabolism in Cardiovascular Disease—From Bench to Bedside
- Characterization of the SGLT2 Interaction Network and Its Regulation by SGLT2 Inhibitors: A Bioinformatic Analysis
- Early Treatment with Empagliflozin and GABA Improves β-Cell Mass and Glucose Tolerance in Streptozotocin-Treated Mice
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.