TY - JOUR
T1 - When intensive insulin therapy (MDi) fails in patients with type 2 diabetes
T2 - Switching to GLP-1 receptor agonist versus insulin pump
AU - Cohen, Ohad
AU - Filetti, Sebastiano
AU - Castaneda, Javier
AU - Maranghi, Marianna
AU - Glandt, Mariela
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Treatment with insulin, alone or with oral or injectable hypoglycemic agents, is becoming increasingly common in patients with type 2 diabetes. However, approximately 40% of patients fail to reach their glycemic targets with the initially prescribed regimen and require intensification of insulin therapy, which increases the risks of weight gain and hypoglycemia. Many of these patients eventually reach a state in which further increases in the insulin dosage fail to improve glycemic control while increasing the risks of weight gain and hypoglycemia. The recently completed OpT2mise clinical trial showed that continuous subcutaneous insulin infusion (CSII) is more effective in reducing glycated hemoglobin (HbA1c) than intensification of multiple daily injection (MDi) insulin therapy in patients with type 2 diabetes who do not respond to intensive insulin therapy. CSII therapy may also be useful in patients who do not reach glycemic targets despite multidrug therapy with basal-bolus insulin and other agents, including glucagon-like peptide (GLP)-1 receptor agonists; current guidelines offer no recommendations for the treatment of such patients. Importantly, insulin and GLP-1 receptor agonists have complementary effects on glycemia and, hence, can be used either sequentially or in combination in the initial management of diabetes. Patients who have not previously failed GLP-1 receptor agonist therapy may show reduction in weight and insulin dose, in addition to moderate improvement in HbA1c, when GLP-1 receptor agonist therapy is added to MDi regimens. In subjects with long-standing type 2 diabetes who do not respond to intensive insulin therapies, switching fromMDi to CSII and/or the addition of GLP-1 receptor agonists toMDi have the potential to improve glycemic control without increasing the risk of adverse events.
AB - Treatment with insulin, alone or with oral or injectable hypoglycemic agents, is becoming increasingly common in patients with type 2 diabetes. However, approximately 40% of patients fail to reach their glycemic targets with the initially prescribed regimen and require intensification of insulin therapy, which increases the risks of weight gain and hypoglycemia. Many of these patients eventually reach a state in which further increases in the insulin dosage fail to improve glycemic control while increasing the risks of weight gain and hypoglycemia. The recently completed OpT2mise clinical trial showed that continuous subcutaneous insulin infusion (CSII) is more effective in reducing glycated hemoglobin (HbA1c) than intensification of multiple daily injection (MDi) insulin therapy in patients with type 2 diabetes who do not respond to intensive insulin therapy. CSII therapy may also be useful in patients who do not reach glycemic targets despite multidrug therapy with basal-bolus insulin and other agents, including glucagon-like peptide (GLP)-1 receptor agonists; current guidelines offer no recommendations for the treatment of such patients. Importantly, insulin and GLP-1 receptor agonists have complementary effects on glycemia and, hence, can be used either sequentially or in combination in the initial management of diabetes. Patients who have not previously failed GLP-1 receptor agonist therapy may show reduction in weight and insulin dose, in addition to moderate improvement in HbA1c, when GLP-1 receptor agonist therapy is added to MDi regimens. In subjects with long-standing type 2 diabetes who do not respond to intensive insulin therapies, switching fromMDi to CSII and/or the addition of GLP-1 receptor agonists toMDi have the potential to improve glycemic control without increasing the risk of adverse events.
UR - http://www.scopus.com/inward/record.url?scp=84979642752&partnerID=8YFLogxK
U2 - 10.2337/dcS15-3029
DO - 10.2337/dcS15-3029
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C2 - 27440831
AN - SCOPUS:84979642752
SN - 0149-5992
VL - 39
SP - S180-S186
JO - Diabetes Care
JF - Diabetes Care
ER -