Free Versus Fixed-Ratio Combination of Basal Insulin and GLP-1 Receptor Agonists in Type 2 Diabetes Uncontrolled With GLP-1 Receptor Agonists: A Systematic Review and Indirect Treatment Comparison
IntroductionThis study evaluates the efficacy and safety of the free up-titration of basal insulin and fixed-ratio combination (FRC) of basal insulin and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in type 2 diabetes mellitus (T2DM) patients inadequately controlled with GLP-1RA.MethodsWith...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-05-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2022.870722/full |
| _version_ | 1811249870908948480 |
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| author | Han Na Jung Han Na Jung Yun Kyung Cho Se Hee Min Se Hee Min Hwi Seung Kim Hwi Seung Kim Ye-Jee Kim Joong-Yeol Park Joong-Yeol Park Woo Je Lee Woo Je Lee Chang Hee Jung Chang Hee Jung |
| author_facet | Han Na Jung Han Na Jung Yun Kyung Cho Se Hee Min Se Hee Min Hwi Seung Kim Hwi Seung Kim Ye-Jee Kim Joong-Yeol Park Joong-Yeol Park Woo Je Lee Woo Je Lee Chang Hee Jung Chang Hee Jung |
| author_sort | Han Na Jung |
| collection | DOAJ |
| description | IntroductionThis study evaluates the efficacy and safety of the free up-titration of basal insulin and fixed-ratio combination (FRC) of basal insulin and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in type 2 diabetes mellitus (T2DM) patients inadequately controlled with GLP-1RA.MethodsWith the use of a systematic literature review of PubMed, Embase, Web of Science, and the Cochrane Library databases through July 2021, randomized controlled trials that compared the free up-titration or FRC with remaining on GLP-1RA in T2DM patients uncontrolled with GLP-1RA were included. A comparison of adding basal insulin to maintaining GLP-1RA and an indirect comparison between the two strategies were conducted on the change in HbA1c, fasting plasma glucose (FPG), target achievement [HbA1c < 7.0%], and the risk of confirmed hypoglycemia. The Cochrane Collaboration’s tool was used to assess the risk of bias.ResultsTwo free up-titration and two FRC trials involving 1,612 participants, all lasting 26 weeks, were included. Both approaches significantly lowered HbA1c levels (weighted mean difference [WMD] −0.75%, 95% CI −0.97 to −0.53) but increased hypoglycemic risk [risk ratio (RR) 7.59, 95% CI 3.35−17.17] compared to the unchanged GLP-1RA. No significant differences were discovered between the two methods regarding the decrease in HbA1c (WMD 0.08%, 95% CI −1.07% to 1.23%), FPG (WMD −2.29 mg/dl, 95% CI −45.07 to 40.49 mg/dl), target achievement (RR 1.03, 95% CI 0.50−2.14), and hypoglycemic risk (RR 0.32, 95% CI 0.03−3.59).ConclusionIn patients who failed to reach target HbA1c levels despite the GLP-1RA treatment, both strategies of adding basal insulin, free up-titration and FRC, are comparable options are comparable options. |
| first_indexed | 2024-04-12T15:54:06Z |
| format | Article |
| id | doaj.art-77c16391349042d0af6a0259a1d1eb4c |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-04-12T15:54:06Z |
| publishDate | 2022-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-77c16391349042d0af6a0259a1d1eb4c2022-12-22T03:26:25ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922022-05-011310.3389/fendo.2022.870722870722Free Versus Fixed-Ratio Combination of Basal Insulin and GLP-1 Receptor Agonists in Type 2 Diabetes Uncontrolled With GLP-1 Receptor Agonists: A Systematic Review and Indirect Treatment ComparisonHan Na Jung0Han Na Jung1Yun Kyung Cho2Se Hee Min3Se Hee Min4Hwi Seung Kim5Hwi Seung Kim6Ye-Jee Kim7Joong-Yeol Park8Joong-Yeol Park9Woo Je Lee10Woo Je Lee11Chang Hee Jung12Chang Hee Jung13Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaAsan Diabetes Center, Asan Medical Center, Seoul, South KoreaDepartment of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, South KoreaDepartment of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaAsan Diabetes Center, Asan Medical Center, Seoul, South KoreaDepartment of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaAsan Diabetes Center, Asan Medical Center, Seoul, South KoreaDepartment of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaDepartment of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaAsan Diabetes Center, Asan Medical Center, Seoul, South KoreaDepartment of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaAsan Diabetes Center, Asan Medical Center, Seoul, South KoreaDepartment of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South KoreaAsan Diabetes Center, Asan Medical Center, Seoul, South KoreaIntroductionThis study evaluates the efficacy and safety of the free up-titration of basal insulin and fixed-ratio combination (FRC) of basal insulin and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in type 2 diabetes mellitus (T2DM) patients inadequately controlled with GLP-1RA.MethodsWith the use of a systematic literature review of PubMed, Embase, Web of Science, and the Cochrane Library databases through July 2021, randomized controlled trials that compared the free up-titration or FRC with remaining on GLP-1RA in T2DM patients uncontrolled with GLP-1RA were included. A comparison of adding basal insulin to maintaining GLP-1RA and an indirect comparison between the two strategies were conducted on the change in HbA1c, fasting plasma glucose (FPG), target achievement [HbA1c < 7.0%], and the risk of confirmed hypoglycemia. The Cochrane Collaboration’s tool was used to assess the risk of bias.ResultsTwo free up-titration and two FRC trials involving 1,612 participants, all lasting 26 weeks, were included. Both approaches significantly lowered HbA1c levels (weighted mean difference [WMD] −0.75%, 95% CI −0.97 to −0.53) but increased hypoglycemic risk [risk ratio (RR) 7.59, 95% CI 3.35−17.17] compared to the unchanged GLP-1RA. No significant differences were discovered between the two methods regarding the decrease in HbA1c (WMD 0.08%, 95% CI −1.07% to 1.23%), FPG (WMD −2.29 mg/dl, 95% CI −45.07 to 40.49 mg/dl), target achievement (RR 1.03, 95% CI 0.50−2.14), and hypoglycemic risk (RR 0.32, 95% CI 0.03−3.59).ConclusionIn patients who failed to reach target HbA1c levels despite the GLP-1RA treatment, both strategies of adding basal insulin, free up-titration and FRC, are comparable options are comparable options.https://www.frontiersin.org/articles/10.3389/fendo.2022.870722/fullbasal insulinfixed-ratio combinationfree up-titrationGLP-1RAmeta-analysis |
| spellingShingle | Han Na Jung Han Na Jung Yun Kyung Cho Se Hee Min Se Hee Min Hwi Seung Kim Hwi Seung Kim Ye-Jee Kim Joong-Yeol Park Joong-Yeol Park Woo Je Lee Woo Je Lee Chang Hee Jung Chang Hee Jung Free Versus Fixed-Ratio Combination of Basal Insulin and GLP-1 Receptor Agonists in Type 2 Diabetes Uncontrolled With GLP-1 Receptor Agonists: A Systematic Review and Indirect Treatment Comparison Frontiers in Endocrinology basal insulin fixed-ratio combination free up-titration GLP-1RA meta-analysis |
| title | Free Versus Fixed-Ratio Combination of Basal Insulin and GLP-1 Receptor Agonists in Type 2 Diabetes Uncontrolled With GLP-1 Receptor Agonists: A Systematic Review and Indirect Treatment Comparison |
| title_full | Free Versus Fixed-Ratio Combination of Basal Insulin and GLP-1 Receptor Agonists in Type 2 Diabetes Uncontrolled With GLP-1 Receptor Agonists: A Systematic Review and Indirect Treatment Comparison |
| title_fullStr | Free Versus Fixed-Ratio Combination of Basal Insulin and GLP-1 Receptor Agonists in Type 2 Diabetes Uncontrolled With GLP-1 Receptor Agonists: A Systematic Review and Indirect Treatment Comparison |
| title_full_unstemmed | Free Versus Fixed-Ratio Combination of Basal Insulin and GLP-1 Receptor Agonists in Type 2 Diabetes Uncontrolled With GLP-1 Receptor Agonists: A Systematic Review and Indirect Treatment Comparison |
| title_short | Free Versus Fixed-Ratio Combination of Basal Insulin and GLP-1 Receptor Agonists in Type 2 Diabetes Uncontrolled With GLP-1 Receptor Agonists: A Systematic Review and Indirect Treatment Comparison |
| title_sort | free versus fixed ratio combination of basal insulin and glp 1 receptor agonists in type 2 diabetes uncontrolled with glp 1 receptor agonists a systematic review and indirect treatment comparison |
| topic | basal insulin fixed-ratio combination free up-titration GLP-1RA meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2022.870722/full |
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