A meta‐analysis comparing clinical effects of short‐ or long‐acting GLP ‐1 receptor agonists versus insulin treatment from head‐to‐head studies in type 2 diabetic patients
Abstract
Aims To study differences in clinical outcomes between initiating glucagon-like peptide-1 receptor agonist (GLP-1 RAs) vs insulin treatment in patients with type 2 diabetes treated with oral glucose-lowering medications (OGLM). Methods Prospective, randomized trials comparing GLP-1 RA and insulin treatment head-to-head as add-on to OGLM were identified (PubMed). Differences from baseline values were compared for HbA1c, fasting plasma glucose, bodyweight, blood pressure, heartrate and lipoproteins. Proportions of patients reporting hypoglycaemic episodes were compared. Results Of 712 publications identified, 23 describing 19 clinical trials were included in the meta-analysis. Compared to insulin, GLP-1 RAs reduced HbA1c more effectively (Δ -.12%, P Conclusions Slightly better glycaemic control can be achieved by adding GLP-1 RAs to OGLM as compared to insulin treatment, with added benefits regarding bodyweight, hypoglycaemia, blood pressure and lipoproteins. These differences are in contrast to the fact that insulin is prescribed far more often than GLP-1 RAs.
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A meta-analysis comparing GLP-1 receptor agonists with insulins in patients with T2D found improvements in blood pressure and atherogenic lipid levels and a reduced rate of hypoglycemia for GLP-1 receptor agonist users.
“A meta-analysis comparing the GLP-1 receptor agonists with insulins in patients with T2D found improvements in blood pressure and atherogenic lipid levels and a reduced rate of hypoglycemia for the GLP-1 receptor agonist users.23”
From Trends in glucagon-like peptide 1 receptor agonist use, 2014 to 2022. (2024) · cites this paper as [23]
In trials analyzing addition of injectable GLP-1 RA, dual GIP and GLP-1 RA, or insulin in people needing further glucose lowering, glycemic efficacies of GLP-1 RAs and the dual GIP and GLP-1 RA were similar to or greater than that of basal insulin.
“In trials analyzing the addition of an injectable GLP-1 RA, dual GIP and GLP-1 RA, or insulin in people needing further glucose lowering, glycemic efficacies of GLP-1 RAs and the dual GIP and GLP-1 RA were similar to or greater than that of basal insulin (123-130).”
From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [126]
GLP-1 RAs and dual GIP and GLP-1 RA in these trials had a lower risk of hypoglycemia compared with insulin.
“GLP-1 RAs and dual GIP and GLP-1 RA in these trials also had a lower risk of hypoglycemia and beneficial effects on body weight compared with insulin, albeit with greater gastrointestinal side effects.”
From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [126]
GLP-1 RAs and dual GIP and GLP-1 RA in these trials had greater gastrointestinal side effects compared with insulin.
“GLP-1 RAs and dual GIP and GLP-1 RA in these trials also had a lower risk of hypoglycemia and beneficial effects on body weight compared with insulin, albeit with greater gastrointestinal side effects.”
From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [126]
GLP-1 RAs and dual GIP and GLP-1 RA in these trials had beneficial effects on body weight compared with insulin.
“GLP-1 RAs and dual GIP and GLP-1 RA in these trials also had a lower risk of hypoglycemia and beneficial effects on body weight compared with insulin, albeit with greater gastrointestinal side effects.”
From 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025 (2025) · cites this paper as [126]
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- Authors
- Abd El Aziz, M. S., Kahle, M., Meier, J. J., & Nauck, M. A.
- Affiliations
- Division of Diabetology, Department of Internal Medicine I, St. Josef‐Hospital Ruhr‐University Bochum Bochum Germany
- St. Josef-Hospital (DE)
- Corresponding author
- Nauck, Michael A.
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2016-11-29
- Volume
- 19
- Issue
- 2
- Pages
- 216-227
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- OpenAlex
- W2527920149
- Cited by
- 155
- References
- 14
- Citations by year
- 2026: 4 · 2025: 14 · 2024: 12 · 2023: 17 · 2022: 14 · 2021: 14 · 2020: 28 · 2019: 20 · 2018: 20 · 2017: 10 · 2016: 2
- FWCI
- 2.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Obesity and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Keywords
- GLP-1 receptor agonists, insulin therapy, type 2 diabetes, glycemic control, HbA1c, fasting blood glucose, body weight, hypoglycemia, blood pressure, heart rate, lipoproteins, triglycerides, LDL cholesterol
- MeSH terms
- Liraglutide, Exenatide, Glucagon-Like Peptide-1 Receptor Agonists, Blood Glucose, Blood Pressure, Body Weight, Diabetes Mellitus, Type 2, Fasting, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Peptides, Venoms, Treatment Outcome, Incretins
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