School of Medicine and Health Sciences Poster Presentations
Use of Metformin, Pre-mixed Insulin and Glucagon-Like Peptide-1 Receptor Agonist as a Therapeutic Approach for Uncontrolled Type 2 Diabetes Mellitus
Document Type
Poster
Abstract Category
Health Sciences
Keywords
Type 2 Diabetes Mellitus, Insulin-Dependent, Obesity
Publication Date
Spring 5-1-2019
Abstract
Objective: To explore the use of premixed insulin, glucagon-like peptide-1 receptor agonist (GLP-1 RA) and metformin as a combination therapy for Type 2 Diabetes Mellitus (T2DM) over 12 months. Methods: All adult patients with T2DM who had been given premixed insulin and a form of GLP-1-RA simultaneously at our outpatient clinic were selected for retrospective review. We reviewed Hemoglobin A1c (HbA1c), weight, cumulative daily insulin dose, and adverse events over 12 months. Results: A total of 72 patients received premixed insulin and GLP-1 RA with 32 patients meeting inclusion criteria. Average duration of T2DM was 14.2 (Standard Deviation [SD] 7.1) years. Mean HbA1c at baseline was 10.5%±2.1 (91 mmol/mol). At 12 months mean HbA1c was 8.3%±1.9 (67 mmol/mol). Mean HbA1c change after 12 months was -2.2 (95% Confidence Interval [CI] -3.433 to -1.014; p < 0.0001). At 12 months, cumulative insulin dose was 33.3 units less than total insulin dose prior to therapy change (CI -57.13 to -9.46; P = 0.0030). Average weight loss at 12 months was -2.2kg (CI -27.6 to 37.6, p = 0.9293). After 12 months, 61% (19 out of 31) had HbA1c ≤ 8% (64 mmol/mol). Of note, adverse events were seen in six additional patients not included in analysis as they stopped regimen after <3 months. Conclusion: Despite decreasing cumulative daily dose of insulin, patients with historically uncontrolled T2DM using metformin, premixed insulin and GLP-1 RA had improved glycemic control over 12 months. Prospective randomized studies need to be done to assess the benefit of this combination of available medication therapy.
Open Access
1
Use of Metformin, Pre-mixed Insulin and Glucagon-Like Peptide-1 Receptor Agonist as a Therapeutic Approach for Uncontrolled Type 2 Diabetes Mellitus
Objective: To explore the use of premixed insulin, glucagon-like peptide-1 receptor agonist (GLP-1 RA) and metformin as a combination therapy for Type 2 Diabetes Mellitus (T2DM) over 12 months. Methods: All adult patients with T2DM who had been given premixed insulin and a form of GLP-1-RA simultaneously at our outpatient clinic were selected for retrospective review. We reviewed Hemoglobin A1c (HbA1c), weight, cumulative daily insulin dose, and adverse events over 12 months. Results: A total of 72 patients received premixed insulin and GLP-1 RA with 32 patients meeting inclusion criteria. Average duration of T2DM was 14.2 (Standard Deviation [SD] 7.1) years. Mean HbA1c at baseline was 10.5%±2.1 (91 mmol/mol). At 12 months mean HbA1c was 8.3%±1.9 (67 mmol/mol). Mean HbA1c change after 12 months was -2.2 (95% Confidence Interval [CI] -3.433 to -1.014; p < 0.0001). At 12 months, cumulative insulin dose was 33.3 units less than total insulin dose prior to therapy change (CI -57.13 to -9.46; P = 0.0030). Average weight loss at 12 months was -2.2kg (CI -27.6 to 37.6, p = 0.9293). After 12 months, 61% (19 out of 31) had HbA1c ≤ 8% (64 mmol/mol). Of note, adverse events were seen in six additional patients not included in analysis as they stopped regimen after <3 months. Conclusion: Despite decreasing cumulative daily dose of insulin, patients with historically uncontrolled T2DM using metformin, premixed insulin and GLP-1 RA had improved glycemic control over 12 months. Prospective randomized studies need to be done to assess the benefit of this combination of available medication therapy.
Comments
Presented at Research Days 2019.