Affiliation:
1. Diabetes Division, Katholisches Klinikum Bochum, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
Abstract
PURPOSE
To compare the efficacy and safety of short- and long-acting glucagon-like peptide 1 receptor agonists (GLP-1 RAs), both used in combination with basal insulin, in patients with type 2 diabetes.
DATA SOURCES AND STUDY SELECTION
Randomized controlled trials comparing the coadministration of short- or long-acting GLP-1 RAs and basal insulin with basal insulin ± placebo were identified (PubMed search). Of 974 identified publications, 14 clinical trials were included. Eight trials examined short-acting and six long-acting GLP-1 RAs.
DATA EXTRACTION AND DATA SYNTHESIS
Differences in HbA1c, fasting plasma glucose, body weight, and adverse events were compared between studies using short- or long-acting GLP-1 RAs by random-effects meta-analysis.
LIMITATIONS
There were relatively small numbers of available publications, some heterogeneity regarding protocols, and differences in the GLP-1 RA compound used.
CONCLUSIONS
Long-acting GLP-1 RAs more effectively reduced HbA1c (∆ −6 mmol/mol [95% CI −10; −2], P = 0.007), fasting plasma glucose (∆ −0.7 mmol/L [−1.2; −0.3], P = 0.007), and body weight (∆ −1.4 kg [−2.2; −0.6], P = 0.002) and raised the proportion of patients achieving an HbA1c target <7.0% (<53 mmol/mol) (P = 0.03) more than the short-acting ones. Patients reporting symptomatic (P = 0.048) but not severe (P = 0.96) hypoglycemia were fewer with long- versus short-acting GLP-1 RAs added to insulin. A lower proportion of patients reported nausea (−52%, P < 0.0001) or vomiting (−36%, P = 0.0002) with long-acting GLP-1 RAs. Overall, GLP-1 RAs improved HbA1c, fasting plasma glucose, and body weight when added to basal insulin. However, long-acting GLP-1 RAs were significantly more effective for glycemic and body weight control and displayed better gastrointestinal tolerability.
Publisher
American Diabetes Association
Subject
Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine
Cited by
52 articles.
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