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Recent studies have suggested that combining basal insulin and glucagon-like peptide-1 (GLP-1) agonists (e.g., exenatide) might be particularly useful in patients with advanced type 2 diabetes. Whereas long-acting insulin targets baseline glucose, GLP-1 agonists can lower postprandial hyperglycemia by inhibiting gastric emptying, stimulating glucose-dependent insulin secretion, and limiting secretion of glucagon. GLP-1 agonists might also cause less hypoglycemia and weight gain than do insulin and other second-line agents.
Researchers conducted a meta-analysis to evaluate combined outcomes from 15 randomized trials (>4300 patients; average duration of diabetes, 12 years) in which basal insulin plus GLP-1 agonists (GLP-1/insulin combinations)…