Current treatment guidelines and glycated haemoglobin goals for type 2 diabetes: Which patients are most likely to benefit from fixed-ratio basal insulin glucagon-like peptide-1 receptor agonist combinations?

Abstract

Basal insulin and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are available in two fixed-ratio combinations (FRCs) for the treatment of type 2 diabetes (T2D), insulin degludec with liraglutide and insulin glargine with lixisenatide. FRCs offer a convenient strategy to administer basal insulin and a GLP-1 RA, taking advantage of complementary mechanisms in a single injection to minimize treatment burden and improve glycemic control while mitigating weight gain. For most, a glycated haemoglobin (HbA1c) goal for patients with T2D using a FRC would be <7%, though it can be adjusted based on patient-specific factors. An HbA1c goal of <6.5% is less likely to be appropriate for patients requiring basal insulin, which is included in the FRCs. Ideal candidates for FRCs are those (1) taking oral antihyperglycemic medications only with an HbA1c <10% and <2% away from goal, (2) those on basal insulin and above HbA1c goal, (3) those unwilling or unable to initiate or manage multiple daily injections (i.e., basal-bolus insulin therapy) and (4) those tolerating a GLP-1 RA who require basal insulin to achieve glycemic goals.

Keywords: GLP‐1 analogue; basal insulin; glycaemic control; type 2 diabetes.

FIGURE 1

Patient characteristics and choosing fixed‐ratio combinations. , characteristic identifying people more likely to benefit from use. , characteristic requiring caution and detailed review before use. , potential benefits of use. GI, gastrointestinal; GLP‐1, glucagon‐like peptide‐1 receptor agonist; MEN2, multiple endocrine neoplasia type 2.