Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Mar 31;19(1):14-27.
doi: 10.1900/RDS.2023.19.14.

Fixed-ratio Combinations (basal Insulin Plus GLP-1RA) In Type 2 Diabetes. an Analytical Review Of Pivotal Clinical Trials

Hernando Vargas-Uricoechea  1 , Juan Pablo Frias  2 , Hernando David Vargas-Sierra  3
Affiliations
Review

Fixed-ratio Combinations (basal Insulin Plus GLP-1RA) In Type 2 Diabetes. an Analytical Review Of Pivotal Clinical Trials

Hernando Vargas-Uricoechea et al. Rev Diabet Stud. .

Abstract

In type 2 diabetes, therapeutic failure to the oral anti diabetics is frequent, the use of schemes with basal insulin or with multiple doses of insulin (basal insulin and short-acting insulins) are a widely accepted way to intensify therapy. The use of GLP-1 receptor agonists is another intensification strategy. The fixedratio combinations with molecules such as insulin degludec + liraglutide, and insulin glargine + lixisenatide have proven useful in intensifying treatment of individuals with type 2 diabetes. The purpose of this review was to evaluate and analyze the results of pivotal studies with both fixed-ratio combinations in individuals with type 2 diabetes, finding that, they are capable of achieving better glycemic control when compared with each of its components separately (with a lower risk of hypoglycemia vs basal insulin and lower risk of gastrointestinal adverse effects vs GLP-1 receptor agonists) in various clinical scenarios, especially in individuals who do not achieve control with oral antidiabetics or who do not achieve control with basal insulin (associated with oral antidiabetics) or in those under management with GLP-1RA plus oral antidiabetics.

PubMed Disclaimer

Conflict of interest statement

H V-U declares Research Support from: Sanofi; Advisory Boards and consulting from: Sanofi, Novo Nordisk, Abbott, PTC Therapeutics and Merck; Speaker Bureau from: Sanofi, Novo Nordisk and PTC Therapeutics.

JP F declares Research Support from: Boehringer Ingelheim, Eli Lilly, Janssen, Merck, Novo Nordisk, Oramed, Pfizer, Sanofi; Advisory Boards and Consulting from: Boehringer Ingelheim, Eli Lilly, Merck, Novo Nordisk, Pfizer and Sanofi; Speaker Bureau from: Eli Lilly, Merck and Sanofi.

HD V-S declares that he has participated in meetings of experts from laboratories such as Sanofi, Novo Nordisk and Abbott.

Figures

Figure 1.
Figure 1.
Results of the LixiLan program on: mean changes from BL in (a), A1c (%); (b), fasting plasma glucose (FPG); (c), 2-hours post-prandial glucose (2 h-PPG)
Figure 2.
Figure 2.
Results of the DUAL program on: changes in A1c value; effects on body weight; and hypoglycemic events in participants with OADs -DUAL I, IV, VI, VIII, and IX- (a); uncontrolled participants with GLP-1RA -DUAL III- (b); and uncontrolled participants with BI -DUAL II, V, and VII- (c) Abbreviations: A1c: glycosylated hemoglobin; PYE: events per patient-year of exposure; 1WT: once-weekly titration; 2WT: twice-weekly titration
Figure 3.
Figure 3.
Recommendation algorithm for starting iGlarLixi Abbreviations: BI: basal insulin; DPP-4i: dipeptidyl peptidase-4 inhibitors; Glin: glinides; GLP-1-1RA: GLP-1 receptor agonist; Pio: Pioglitazone; SGLT2i: sodium-glucose cotransporter 2 inhibitors; SU: Sulphonylurea
Figure 4.
Figure 4.
Recommendation algorithm for starting iDegLira Abbreviations: BI: basal insulin; DPP-4i: dipeptidyl peptidase-4 inhibitors; Glin: glinides; GLP-1-1RA: GLP-1 receptor agonist; Pio: Pioglitazone; SGLT2i: sodium-glucose cotransporter 2 inhibitors; SU: Sulphonylurea
See this image and copyright information in PMC

References

    1. American Diabetes Association Professional Practice Committee; American Diabetes Association Professional Practice Committee: Draznin B, Aroda VR, Bakris G, Benson G, Brown FM, Freeman R, Green J, Huang E, Isaacs D, Kahan S, et al. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022, 45(Suppl 1):S17-38. - PubMed
    1. Roden M, Shulman GI. The integrative biology of type 2 diabetes. Nature 2019, 576(7785):51-60. - PubMed
    1. Farmaki P, Damaskos C, Garmpis N, Garmpi A, Savvanis S, Diamantis E. Complications of the Type 2 Diabetes Mellitus. Curr Cardiol Rev 2020, 16(4):249-51. - PMC - PubMed
    1. Galicia-Garcia U, Benito-Vicente A, Jebari S, LarreaSebal A, Siddiqi H, Uribe KB, Ostolaza H, Martín C. Pathophysiology of Type 2 Diabetes Mellitus. Int J Mol Sci 2020, 21(17):6275. - PMC - PubMed
    1. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, Stein C, Basit A, Chan JCN, Mbanya JC, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract 2022, 183:109119. - PMC - PubMed

MeSH terms

LinkOut - more resources