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Initial injectable therapy in type 2 diabetes: Key considerations when choosing between glucagon-like peptide 1 receptor agonists and insulin.

Publication ,  Journal Article
Alexopoulos, A-S; Buse, JB
Published in: Metabolism
September 2019

Managing type 2 diabetes is complex and necessitates careful consideration of patient factors such as engagement in self-care, comorbidities and costs. Since type 2 diabetes is a progressive disease, many patients will require injectable agents, usually insulin. Recent ADA-EASD guidelines recommend glucagon-like peptide 1 receptor agonists (GLP-1 RAs) as first injectable therapy in most cases. The basis for this recommendation is the similar glycemic efficacy of GLP-1 RAs and insulin, but with GLP-1 RAs promoting weight loss instead of weight gain, at lower hypoglycemia risk, and with cardiovascular benefits in patients with pre-existing cardiovascular disease. GLP-1 RAs also reduce burden of glucose self-monitoring. However, tolerability and costs are important considerations, and notably, rates of drug discontinuation are often higher for GLP-1 RAs than basal insulin. To minimize risk of gastrointestinal symptoms patients should be started on lowest doses of GLP-1 RAs and up-titrated slowly. Overall healthcare costs may be lower with GLP-1 RAs compared to insulin. Though patient-level costs may still be prohibitive, GLP-1 RAs can replace 50-80 units of insulin daily and reduce costs associated with glucose self-monitoring. Decisions regarding initiating injectable therapy should be individualized. This review provides a framework to guide decision-making in the real-world setting.

Duke Scholars

Published In

Metabolism

DOI

EISSN

1532-8600

Publication Date

September 2019

Volume

98

Start / End Page

104 / 111

Location

United States

Related Subject Headings

  • Insulin
  • Injections
  • Hypoglycemic Agents
  • Humans
  • Glucagon-Like Peptide-1 Receptor
  • Glucagon-Like Peptide 1
  • Endocrinology & Metabolism
  • Diabetes Mellitus, Type 2
  • Animals
  • 3202 Clinical sciences
 

Citation

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ICMJE
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Alexopoulos, A.-S., & Buse, J. B. (2019). Initial injectable therapy in type 2 diabetes: Key considerations when choosing between glucagon-like peptide 1 receptor agonists and insulin. Metabolism, 98, 104–111. https://doi.org/10.1016/j.metabol.2019.06.012
Alexopoulos, Anastasia-Stefania, and John B. Buse. “Initial injectable therapy in type 2 diabetes: Key considerations when choosing between glucagon-like peptide 1 receptor agonists and insulin.Metabolism 98 (September 2019): 104–11. https://doi.org/10.1016/j.metabol.2019.06.012.
Alexopoulos, Anastasia-Stefania, and John B. Buse. “Initial injectable therapy in type 2 diabetes: Key considerations when choosing between glucagon-like peptide 1 receptor agonists and insulin.Metabolism, vol. 98, Sept. 2019, pp. 104–11. Pubmed, doi:10.1016/j.metabol.2019.06.012.
Journal cover image

Published In

Metabolism

DOI

EISSN

1532-8600

Publication Date

September 2019

Volume

98

Start / End Page

104 / 111

Location

United States

Related Subject Headings

  • Insulin
  • Injections
  • Hypoglycemic Agents
  • Humans
  • Glucagon-Like Peptide-1 Receptor
  • Glucagon-Like Peptide 1
  • Endocrinology & Metabolism
  • Diabetes Mellitus, Type 2
  • Animals
  • 3202 Clinical sciences