Klink C, Gardetto K, Dilworth T. Criteria for conversion from a basal-bolus insulin regimen in patients with type 2 diabetes to a regimen of a glucagon-like peptide-1 receptor agonist with basal insulin. Poster presented at: Aurora Scientific Day; May 22, 2019; Milwaukee, WI.
Poster presented at: Aurora Scientific Day; May 22, 2019; Milwaukee, WI.
Background: Diabetes mellitus is a metabolic disease in which the body’s production and response to insulin is altered. Type 2 diabetes mellitus is a subset of the disease in which the pancreas continues to produce insulin; however, the level of endogenous insulin production decreases over time. Many patients with type 2 diabetes mellitus eventually require basal-bolus insulin as part of their medication regimen; however, this regimen is complex and increases the risk of hypoglycemia and weight gain. A newer regimen for type 2 diabetes mellitus includes the combination of a glucagon-like peptide-1 receptor agonist (GLP-1RA) plus basal insulin. This regimen is less complex, safer, promotes weight loss, and has the potential to reduce cardiovascular risk. This regimen is incorporated in the American Diabetes Association guidelines as part of the step therapy for diabetes. What is less well known is which patients, if any, may be successfully de-escalated from basal-bolus insulin to this regimen.
Purpose: To identify patient characteristics that predict a successful conversion from a basal-bolus insulin regimen to a basal insulin plus GLP-1RA regimen.
Methods: A retrospective case series was performed on 32 patients with type 2 diabetes mellitus. Of the 32, 24 patients successfully made the conversion from a basal-bolus insulin regimen to GLP1RA plus basal insulin; 8 patients were unsuccessful. Unsuccessful conversions were defined as discontinuation of the GLP-1RA due to intolerance, expense, or clinical decline seen in lab test values. Patient characteristics, including weight, hemoglobin A1c, and blood glucose (average and range), were tracked. C-peptide level, years since diagnosis, and insulin requirements also were analyzed to identify if there may be a correlation with patients who could successfully be converted.
Results: Patients who successfully converted to a GLP-1RA plus basal insulin regimen had an average weight loss of 5.5 ± 2.0 kg and a reduction in average blood sugar of 16.3 ± 51.2 mg/dL at 3 months. They also had an average reduction in A1c of 0.83%; in comparison, patients who were unsuccessful had an average increase in A1c of 0.625%. The average C-peptide value for successfully converted patients was 2.77 ng/ml compared to 0.97 ng/ml for patients who failed the new regimen due to clinical decline.
Conclusion: Patients with type 2 diabetes mellitus presently managed on basal-bolus insulin can be successfully converted to a GLP-1RA plus basal insulin if appropriately screened and selected.