Impact of a weekly glucagon-like peptide 1 receptor agonist, albiglutide, on glycemic control and on reducing prandial insulin use in type 2 diabetes inadequately controlled on multiple insulin therapy: a randomized trial.

Rosenstock, Julio; Nino, Antonio; Soffer, Joseph; Erskine, Lois; Acusta, Andre; Dole, Jo; Carr, Molly C.; Mallory, Jason; Home, Philip

doi:10.2337/dc19-2316

Cited by 73Diabetes Treatment and ManagementDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

Impact of a weekly glucagon-like peptide 1 receptor agonist, albiglutide, on glycemic control and on reducing prandial insulin use in type 2 diabetes inadequately controlled on multiple insulin therapy: a randomized trial.

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Rosenstock, Julio, Nino, Antonio, Soffer, Joseph, Erskine, Lois, Acusta, Andre, Dole, Jo, Carr, Molly C., Mallory, Jason +1 more·2020·Diabetes Care

DOI 10.2337/dc19-2316PMC PMC7510023

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Abstract

OBJECTIVE: The principle of replacing prandial insulin lispro with a once-weekly glucagon-like peptide 1 receptor agonist (GLP-1RA) for type 2 diabetes inadequately controlled on a multiple daily insulin injections regimen was tested with albiglutide. RESEARCH DESIGN AND METHODS: In this treat-to-target study, basal plus prandial insulin was optimized over 4 weeks before participants were randomized (1:1) to albiglutide plus optimized basal insulin glargine and lispro (dose reduced by 50% at randomization; subsequently, lispro injections were fully discontinued 4 weeks later) (n = 402) or to continued optimized lispro plus optimized glargine (n = 412). RESULTS: Mean ± SD HbA1c at baseline, 7.8 ± 0.6% (61 ± 7 mmol/mol) in the albiglutide + glargine group and 7.7 ± 0.6% (60 ± 7 mmol/mol) in the lispro + glargine group, was reduced at week 26 to 6.7 ± 0.8% (49 ± 8 mmol/mol) and 6.6 ± 0.8% (48 ± 8 mmol/mol), respectively (least squares [LS] difference 0.06% [95% CI −0.05 to 0.17]; noninferiority P < 0.0001). In the albiglutide + glargine group, 218 participants (54%) replaced all prandial insulin without reintroducing lispro up to week 26. Total daily prandial insulin dose was similar at baseline but was lower by 62 units/day (95% CI −65.9 to −57.8; P < 0.0001) at week 26 in the albiglutide + glargine group, and the total number of weekly injections was also reduced from 29 to 13 per week. Less severe/documented symptomatic hypoglycemia (57.2% vs. 75.0%) occurred in the albiglutide + glargine group with meaningful weight differences (LS mean ± SE −2.0 ± 0.2 vs. +2.4 ± 0.2 kg; P < 0.0001) vs. lispro + glargine. Gastrointestinal adverse events were higher with albiglutide + glargine (26% vs. 13%). CONCLUSIONS: A once-weekly GLP-1RA was able to substitute for prandial insulin in 54% of people, substantially reducing the number of prandial insulin injections; glycemic control improved, with the added benefits of weight loss and less hypoglycemia in the GLP-1RA arm. Replacing prandial insulin with a weekly GLP-1RA can simplify basal plus prandial insulin treatments and achieve better outcomes in type 2 diabetes.

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When added to basal insulin, selective GLP-1 receptor agonists have demonstrated improved glycemic control and body weight loss without increasing the risk of hypoglycemia and reducing insulin requirements.
“When added to basal insulin, selective glucagon-like peptide-1 (GLP-1) receptor agonists have demonstrated improved glycemic control and body weight loss without increasing the risk of hypoglycemia and reducing insulin requirements.[2][3][4][5][6]”
From Effect of Subcutaneous Tirzepatide vs Placebo Added to Titrated Insulin Glargine on Glycemic Control in Patients With Type 2 Diabetes (2022) · cites this paper as [4]

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Efficacy and safety of once‐weekly glucagon‐like peptide 1 receptor agonist albiglutide ( HARMONY 1 trial): 52‐week primary endpoint results from a randomized, double‐blind, placebo‐controlled trial in patients with type 2 diabetes mellitus not controlled on pioglitazone, with or without metformin
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Authors: Rosenstock, J., Nino, A., Soffer, J., Erskine, L., Acusta, A., Dole, J., Carr, M. C., Mallory, J., & Home, P.
Affiliations: Dallas Diabetes Research Center (US)
GlaxoSmithKline (United States) (US)
Newcastle University (GB)
Corresponding author: Rosenstock, Julio
ORCID: Rosenstock, Julio
Nino, Antonio
Soffer, Joseph
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2020-07-21
Volume: 43
Issue: 10
Pages: 2509-2518
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/dc19-2316
PMC: PMC7510023
OpenAlex: W3045471137
Semantic Scholar: ac472ce70e89e93fbd236be19e9d114ca008a5d2
Cited by: 73
References: 31
Citations by year: 2026: 9 · 2025: 14 · 2024: 20 · 2023: 7 · 2022: 13 · 2021: 8 · 2020: 2
FWCI: 5.66
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.diabetesjournals.org/content/license (vor, 62 d)
Locations: Diabetes Care (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Newcastle University ePrints (Newcastle Univesity)
Funders: GlaxoSmithKline
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 › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords: albiglutide, GLP-1 receptor agonists, type 2 diabetes, glycemic control, basal insulin glargine, insulin lispro, multiple daily insulin injections, HbA1c, hypoglycemia, weight gain, insulin dose reduction, treat-to-target, non-inferiority
MeSH terms: Insulin Glargine, Glycemic Control, Adult, Aged, Blood Glucose, Diabetes Mellitus, Type 2, Dose-Response Relationship, Drug, Drug Administration Schedule, Drug Therapy, Combination, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Insulin, Male, Middle Aged, Treatment Failure, Glucagon-Like Peptide 1, Young Adult, Insulin Lispro, Meals

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Impact of a weekly glucagon-like peptide 1 receptor agonist, albiglutide, on glycemic control and on reducing prandial insulin use in type 2 diabetes inadequately controlled on multiple insulin therapy: a randomized trial.

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