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Initial injectable therapy in type 2 diabetes: Key considerations when choosing between glucagon-like peptide 1 receptor agonists and insulin.
Metabolism. 2019 09; 98:104-111.M

Abstract

Managing type 2 diabetes is complex and necessitates careful consideration of patient factors such as engagement in self-care, comorbidities and costs. Since type 2 diabetes is a progressive disease, many patients will require injectable agents, usually insulin. Recent ADA-EASD guidelines recommend glucagon-like peptide 1 receptor agonists (GLP-1 RAs) as first injectable therapy in most cases. The basis for this recommendation is the similar glycemic efficacy of GLP-1 RAs and insulin, but with GLP-1 RAs promoting weight loss instead of weight gain, at lower hypoglycemia risk, and with cardiovascular benefits in patients with pre-existing cardiovascular disease. GLP-1 RAs also reduce burden of glucose self-monitoring. However, tolerability and costs are important considerations, and notably, rates of drug discontinuation are often higher for GLP-1 RAs than basal insulin. To minimize risk of gastrointestinal symptoms patients should be started on lowest doses of GLP-1 RAs and up-titrated slowly. Overall healthcare costs may be lower with GLP-1 RAs compared to insulin. Though patient-level costs may still be prohibitive, GLP-1 RAs can replace 50-80 units of insulin daily and reduce costs associated with glucose self-monitoring. Decisions regarding initiating injectable therapy should be individualized. This review provides a framework to guide decision-making in the real-world setting.

Authors+Show Affiliations

Duke University Medical Center, Durham, NC, United States. Electronic address: asa61@duke.edu.University of North Carolina, Chapel Hill, NC, United States.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Review

Language

eng

PubMed ID

31255662

Citation

Alexopoulos, Anastasia-Stefania, and John B. Buse. "Initial Injectable Therapy in Type 2 Diabetes: Key Considerations when Choosing Between Glucagon-like Peptide 1 Receptor Agonists and Insulin." Metabolism: Clinical and Experimental, vol. 98, 2019, pp. 104-111.
Alexopoulos AS, Buse JB. Initial injectable therapy in type 2 diabetes: Key considerations when choosing between glucagon-like peptide 1 receptor agonists and insulin. Metabolism. 2019;98:104-111.
Alexopoulos, A. S., & Buse, J. B. (2019). Initial injectable therapy in type 2 diabetes: Key considerations when choosing between glucagon-like peptide 1 receptor agonists and insulin. Metabolism: Clinical and Experimental, 98, 104-111. https://doi.org/10.1016/j.metabol.2019.06.012
Alexopoulos AS, Buse JB. Initial Injectable Therapy in Type 2 Diabetes: Key Considerations when Choosing Between Glucagon-like Peptide 1 Receptor Agonists and Insulin. Metabolism. 2019;98:104-111. PubMed PMID: 31255662.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Initial injectable therapy in type 2 diabetes: Key considerations when choosing between glucagon-like peptide 1 receptor agonists and insulin. AU - Alexopoulos,Anastasia-Stefania, AU - Buse,John B, Y1 - 2019/06/27/ PY - 2019/04/14/received PY - 2019/06/17/revised PY - 2019/06/24/accepted PY - 2019/7/1/pubmed PY - 2020/2/20/medline PY - 2019/7/1/entrez SP - 104 EP - 111 JF - Metabolism: clinical and experimental JO - Metabolism VL - 98 N2 - Managing type 2 diabetes is complex and necessitates careful consideration of patient factors such as engagement in self-care, comorbidities and costs. Since type 2 diabetes is a progressive disease, many patients will require injectable agents, usually insulin. Recent ADA-EASD guidelines recommend glucagon-like peptide 1 receptor agonists (GLP-1 RAs) as first injectable therapy in most cases. The basis for this recommendation is the similar glycemic efficacy of GLP-1 RAs and insulin, but with GLP-1 RAs promoting weight loss instead of weight gain, at lower hypoglycemia risk, and with cardiovascular benefits in patients with pre-existing cardiovascular disease. GLP-1 RAs also reduce burden of glucose self-monitoring. However, tolerability and costs are important considerations, and notably, rates of drug discontinuation are often higher for GLP-1 RAs than basal insulin. To minimize risk of gastrointestinal symptoms patients should be started on lowest doses of GLP-1 RAs and up-titrated slowly. Overall healthcare costs may be lower with GLP-1 RAs compared to insulin. Though patient-level costs may still be prohibitive, GLP-1 RAs can replace 50-80 units of insulin daily and reduce costs associated with glucose self-monitoring. Decisions regarding initiating injectable therapy should be individualized. This review provides a framework to guide decision-making in the real-world setting. SN - 1532-8600 UR - https://www.unboundmedicine.com/medline/citation/31255662/Initial_injectable_therapy_in_type_2_diabetes:_Key_considerations_when_choosing_between_glucagon_like_peptide_1_receptor_agonists_and_insulin_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0026-0495(19)30127-1 DB - PRIME DP - Unbound Medicine ER -