Dr Landi Lombard who is a specialist physician and endocrinologist in private practice in Cape Town explained the benefits of this new combination treatment.
“Despite the range of pharmaceutical options available, we are not controlling our patients and a different approach is required to get our patients to target earlier, better and for a prolonged period of time, to prevent long-term complications,” he said.
“Delayed treatment intensification is a big problem. The legacy effect in type two diabetes is real and the impact of early glycaemic control on future morbidity has been illustrated.
When looking at the first year of control, this correlates with mortality. It is therefore critical to manage diabetic patients early and aggressively targeting normal range HbA1c. There is currently a shift to simultaneous approaches to treatment instead of using single agents for successful outcomes, using powerful agents,” he said.
Dr Lambert looked at real-world studies showing the experience of glycaemic control and medication adherence in T2DM. Patients who were started on glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and basal insulin (BI) at the same time had the best outcomes. The longer it took to add the GLP-1 RAs, the worse the HbA1c lowering was. Patients who started on the combination had the best HbA1c after 12 months and the biggest reduction, close to 2%, of HbA1c.
Among patients who had inadequately controlled disease on oral antidiabetic drugs (OADs), simultaneous initiation of BI and a GLP-1 RA resulted in significantly better glycaemic control than sequential initiation of B1 and GLP-1 RA with a gap beyond 90 days. A longer gap between the initiation of B1 and GLP-1 RA therapy was associated with poorer glycaemic control outcomes.
Another real-world retrospective study indicates that initiating GLP-1 RA and BI therapies relatively close together (ideally 30 days or less) leads to a significantly greater probability of reaching glycaemic control compared with initiating these two therapies 91-360 days apart.
Characteristics of combining insulin glargine 100 units/ml and lixisenatide:
- Single daily injection within the hour prior to the first meal of the day
- Greater HB A1 C reduction versus its individual components
- Reduction in FPG and PPG
- More people reach HB A1 C goal versus the individual components
- Mitigates the weight gain commonly experienced with basal insulin
- No additional risk of hypoglycaemia vs basal insulin.
HbA1c target achievement without weight gain and without hypoglycaemia was also significantly greater with the fixed-dose combination vs premixed insulin.
“In summary, the insulin glargine and lixisenatide combination is an exciting powerful, safe yet simple new combination therapy to be used early in T2DM patients not controlled on metformin. It can be used in combination with other oral agents except (DPP-4 inhibitors) or in replacing basal insulin or mixed insulins,” Dr Lombard concluded.