Dr. LEE Chi Ho
The University of Hong Kong:
Clinical Assistant Professor, Department of Medicine (2015 – Present)
Queen Mary Hospital, Hospital Authority:
Honorary Associate Consultant, Department of Medicine (2019 – Present)
Abstract
Early Intensification Therapy of Fixed Ratio Combination of Basal analogue & GLP-1 RA
By Dr. Paul Lee
Both glucagon-like peptide 1 receptor agonists (GLP1rA) and insulin therapy are effective injectable therapies for the treatment of type 2 diabetes (T2D). Their actions are complementary to each other and their combination therefore provides an attractive therapeutic strategy. Indeed, in the latest guidelines from the American Diabetes Association, it was also recommended that combination therapy with a GLP1rA should be considered in patients on insulin therapy for greater efficacy and durability of treatment effect. Moreover, a fixed-ratio combination (FRC) product such as iGlarLixi consisting of glargine and lixisenatide, can be considered if patients are put on both GLP1rA and basal insulin therapy. (1)
However, intensification of treatment regimen is sometimes difficult in real-life due to multiple factors including clinical inertia of clinicians, patient preference, frequency of injections and convenience issues. The recently published Solimix study is a randomized controlled trial which demonstrated that in T2D patients who were sub-optimally controlled with basal insulin plus one or two oral anti-diabetic agents, the use of FRC for 6 months was non-inferior to premixed insulin therapy in glycaemic control and was superior in weight reduction, allowing a higher proportion of patients reaching their HbA1c goals, and at the same time, without weight gain and hypoglycaemia. (2)
In this talk, the importance and difficulties during early intensification therapy in T2D patients will be presented. Moreover, the role of novel FRC as compared to other intensification strategies will also be discussed.
References:
- American Diabetes Association Professional Practice C, Draznin B, Aroda VR, Bakris G, Benson G, Brown FM, et al. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S125-S43.
- Rosenstock J, Emral R, Sauque-Reyna L, Mohan V, Trescoli C, Al Sifri S, et al. Advancing Therapy in Suboptimally Controlled Basal Insulin-Treated Type 2 Diabetes: Clinical Outcomes With iGlarLixi Versus Premix BIAsp 30 in the SoliMix Randomized Controlled Trial. Diabetes Care. 2021.
