GLP‐1 receptor agonist added to insulin versus basal‐plus or basal‐bolus insulin therapy in type 2 diabetes: A systematic review and meta‐analysis

• Published in: Diabetes/metabolism research and reviews 2019-01, Vol.35 (1), p.e3082-n/a
• Main Authors: Castellana, Marco, Cignarelli, Angelo, Brescia, Francesco, Laviola, Luigi, Giorgino, Francesco
• Format: Article
• Language: English
• Subjects: Body weight; Body weight loss; Clinical trials; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Dosage; Evidence-based medicine; GLP-1 receptor agonists; Glucagon; glucagon‐like peptide‐1 receptor agonist; HbA1c; Hypoglycemia; Insulin; Meta-analysis; Patients; Systematic review; type 2 diabetes mellitus
• ISSN: 1520-7552; 1520-7560
• DOI: 10.1002/dmrr.3082

Background Current guidelines recommend that antihyperglycaemic treatment in patients with type 2 diabetes not achieving the HbA1c target on basal insulin should be intensified with a glucagon‐like peptide‐1 receptor agonist (GLP‐1RA) or basal‐plus/basal‐bolus (BP/BB) insulin regimen. We conducted a systematic review and meta‐analysis to compare the effects of GLP‐1RA/insulin combinations versus BP/BB. Methods The review was registered on PROSPERO (CRD42017079547). PubMed, Scopus, CENTRAL, and ClinicalTrials.gov were searched until July 2018. All randomized controlled trials (RCTs) reporting HbA1c, body weight, daily insulin dose, hypoglycaemic events, and discontinuation due to lack of efficacy were included. A subgroup analysis on different combinations of GLP‐1RA and insulin was performed. Results Out of 1885 retrieved papers, 13 RCTs were included in the review. Compared with BP/BB, GLP‐1RA/insulin combinations were associated with a similar HbA1c reduction (Δ = −0.06%; 95% confidence interval [CI], −0.14 to 0.02; P = 0.13; I2 = 52%), greater weight loss (Δ = −3.72 kg; 95% CI, −4.49 to −2.95; P