Is there a justification for classifying GLP-1 receptor agonists as basal and prandial?

Miñambres, Inka; Pérez, Antonio

doi:10.1186/s13098-017-0204-6

Cited by 22 publications

(21 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Classification of GLP-1 RAs as either basal or prandial specific solely based on duration of action is not justifiable, and could be clinically misleading. 15 The purpose of this post hoc analysis was to evaluate the change in relative contributions of BHG and PPHG to overall hyperglycaemia across different HbA1c categories at baseline and after 6 months of treatment intensification with dulaglutide 1.5 mg as monotherapy or with oral glucose-lowering agents in patients with type 2 diabetes. As an exploratory objective, we aimed to evaluate any differences between dulaglutide and liraglutide, exenatide BID or insulin glargine on the impact on relative contribution of BHG and PPHG to overall hyperglycaemia after 6 months of treatment intensification.…”

Section: Introductionmentioning

confidence: 99%

“…15 The purpose of this post hoc analysis was to evaluate the change in relative contributions of BHG and PPHG to overall hyperglycaemia across different HbA1c categories at baseline and after 6 months of treatment intensification with dulaglutide 1.5 mg as monotherapy or with oral glucose-lowering agents in patients with type 2 diabetes. 15 The purpose of this post hoc analysis was to evaluate the change in relative contributions of BHG and PPHG to overall hyperglycaemia across different HbA1c categories at baseline and after 6 months of treatment intensification with dulaglutide 1.5 mg as monotherapy or with oral glucose-lowering agents in patients with type 2 diabetes.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Relative contribution of basal and postprandial hyperglycaemia stratified by HbA1c categories before and after treatment intensification with dulaglutide

Umpiérrez

Pantalone

Atisso

et al. 2019

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

Aim: To assess the effect of dulaglutide on the relative contribution of basal hyperglycaemia (BHG) and postprandial hyperglycaemia (PPHG) to overall hyperglycaemia across HbA1c categories in patients with type 2 diabetes.Methods: Data from five phase 3 studies (N = 673) were pooled to assess the change in relative contributions of BHG and PPHG to overall hyperglycaemia across different HbA1c categories after 6 months of treatment intensification with dulaglutide 1.5 mg as monotherapy or with 1 or 2 oral medication(s) in patients with type 2 diabetes. BHG and PPHG were calculated using the area under the curve (AUC) of 7-point self-monitored plasma glucose concentration profiles. As a secondary objective, relative contribution of BHG and PPHG for dulaglutide versus liraglutide, exenatide BID and insulin glargine was assessed by individual studies at 6 months. Results: In pooled data, after 6 months of treatment intensification with dulaglutide 1.5 mg, there was a significant reduction from baseline in overall hyperglycaemia (AUC overall ) [(mean ± SE) -466.31 ± 18.32 mg*h/dL (P < 0.001)], BHG (AUC basal ) [(mean ± SE) -371.46 ± 16.36 mg*h/dL (P < 0.001)] and PPHG (AUC postprandial ) [(mean ± SE) -94.84 ± 7.97 mg*h/dL (P < 0.001)]. At baseline, relative contributions of BHG increased and PPHG decreased with increasing HbA1c levels. This pattern was maintained at 6 months, even as overall glycaemia improved with decreasing HbA1c values. Conclusions: In patients with type 2 diabetes, dulaglutide reduces HbA1c by lowering both basal and postprandial hyperglycaemia across various HbA1c levels. K E Y W O R D S basal insulin, dulaglutide, GLP-1 RAs, glycaemic control, type 2 diabetes 1 | INTRODUCTION Widely accepted treatment guidelines recommend an individualized treatment approach towards target HbA1c for patients with type 2 diabetes, based upon cardiovascular disease, life expectancy, disease duration, comorbidities, micro-and macrovascular complications, adherence and other patient-related factors. 1-4 HbA1c is a measure of overall glucose exposure during both fasting and postprandial state, and this interrelationship between the "glucose triad" of HbA1c, fasting glucose and postprandial glucose level changes with progression of the disease. 5 Monnier et al., in a study of 290 patients with type 2 diabetes managed with diet, metformin and/or sulphonylurea, showed that the relative contribution of postprandial hyperglycaemia (PPHG) decreases with increase in HbA1c and the relationship is the opposite for relative contribution of basal hyperglycaemia (BHG) to overall hyperglycaemia. 6 Moreover, the relative contribution of BHG and PPHG to overall hyperglycaemia in patients across a range of HbA1c levels of 7.3-10.2% (56.3-83.0 mmol/mol) was~50%, highlighting the need for drugs that impact both BHG and PPHG for a large proportion of patients. 6 In another study conducted by Riddle et al., in patients with mean baseline HbA1c of 8.7% (71.6 mmol/mol) treated with insulin glargine, the mean relative contribution of BHG t...

show abstract

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Relative contribution of basal and postprandial hyperglycaemia stratified by HbA1c categories before and after treatment intensification with dulaglutide

Umpiérrez

Pantalone

Atisso

et al. 2019

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…When we compare this data with the data of the various AWARD trials some stark differences do stand out all of which can perhaps be explained and some of which can be expected as a part of standard differences which occur in between RCTs and RWE (real world evidence) generated data. Dulaglutide being an once weekly GLP-1RAs is structurally a large molecule and is expected to have a more profound action over fasting plasma glucose rather than on the post prandial plasma glucose levels [11], however in this real world generated data the same was not reflected due to the heterogeneity of concomitant anti diabetic medication which perhaps played a differential role in the control of fasting and post prandial blood glucose levels. AWARD 3 assessed dulaglutide monotherapy at 1.5 gm dose over a 52 week period and achieved an HbA1C reduction of 0.78 ± 0.06 % and this data from the series of AWARD studies was less than the HbA1c reduction achieved in the subset of patients which we included in our study cohort [12].…”

Section: Discussionmentioning

confidence: 99%

First Fabulous Fifty – An Initial Experience of Dulaglutide from a Tertiary Care Centre in Eastern India

2018

Endocrinol Diabetes Metab J

View full text Add to dashboard Cite

Objective: This retrospective single centred real world observational study was undertaken with the aim to introspect the glycaemic control, weight loss, changes in lipid parameters, adverse events and treatment adherence with Dulaglutide therapy. Methodology: Single centered, retrospective, real world, observational study conducted on subjects taking liraglutide for a mean duration of 41 weeks in the endocrine outpatient department. Results: Data of 45 subjects were available. Mean age was 46.67 ± 5.53years. Glycosylated haemoglobin (HbA1c) significantly decreased from 8.68 ± 0.43% at baseline to 7.58 ± 0.19% at end of therapy. Body weight significantly reduced from 74.2 ± 8.07 kg at baseline to 69.27 ± 4.74kg at end of therapy and BMI significantly declined from 33.06 ± 4.5 to 30.09 ± 0.93 at end of therapy respectively. Nausea, vomiting and diarrhoea (15.55%) were the major adverse events noted in the study. Only one patient developed acute pancreatitis (2.22%). Conclusion: Treatment with Dulaglutide resulted in clinically meaningful HbA1c, FPG and weight reductions. The overall safety profile is consistent with the GLP-1 receptor agonist class. However, Dulaglutide did not show statistically greater reduction of glycaemic parameters in the subset of Indian patients compared to RCT data of Western population.

show abstract

“…Megengedett volt az adott kezelés mellett legfeljebb egy orális vércukorcsökkentő -metformin, sulfanylurea-típusú szer a glibenclamid kivételével, meglitinidszármazék, acarbose, dipeptidilpeptidáz-4-gátló -kiegészítő adása is. A négy csoportba egyenként 40, öszszesen 160 személyt vontak be, akiken hatnapos CGMS-sel 7,8,11 LixiLan-O LixiLan-L…”

Section: A Bázisinzulin-glp-1-ra Kombináció Elméleti Háttereunclassified

IGlarLixi – bázisinzulin és GLP-1-receptoragonista új fix kombinációja

Winkler¹

2018

Diabetologia Hungarica

View full text Add to dashboard Cite

Bázisinzulin és glukagonszerű peptid (GLP)-1-receptor-agonista (RA) kombinációja hatásmechanizmusuk részben szinergista, részben komplementer természetéből adódóan hatékonyabban javítja az anyagcserét, fix összetételű változataik kényelmesebbé teszik alkalmazásukat és növelik a terápiás adherenciát. A glargin és a lixisenatid fix összetételű készítménye (IGlarLixi) prandialis természetű GLP-1-RA komponense révén a beadását követő postprandialis vércukorszint erőteljes csökkentése mellett hatékonyan mérsékli a napszakos vércukorértékeket. Két-2:1 (100/50 jelű toll), illetve 3:1 (100/33 jelű toll)-keverékarányú kiszerelésével lehetőséget biztosít kisebb, illetve nagyobb bázisinzulindózis azonos GLP-1-RA-adag mellett történő bejuttatására, elősegítve ezzel az éhomi vagy a postprandialis vércukorszint erőteljesebb mérséklését, ahol az szükséges. A közlemény az IGlarLixi főbb jellemzőinek áttekintése mellett ismerteti a készítmény klinikai bevezetését megelőző III. fázisú vizsgálatokat (LixiLan-O és-L), valamint ezek eddig közlésre került post hoc analíziseit. A vizsgálatok és post hoc analízisek a glukózanyagcsere hatékony javítása mellett megerősítik a készítmény testsúlyra gyakorolt előnyös hatását, alacsony hypoglykaemia-kockázatát és biztonságosságát.

show abstract

Is there a justification for classifying GLP-1 receptor agonists as basal and prandial?

Cited by 22 publications

References 58 publications

Relative contribution of basal and postprandial hyperglycaemia stratified by HbA1c categories before and after treatment intensification with dulaglutide

Relative contribution of basal and postprandial hyperglycaemia stratified by HbA1c categories before and after treatment intensification with dulaglutide

First Fabulous Fifty – An Initial Experience of Dulaglutide from a Tertiary Care Centre in Eastern India

IGlarLixi – bázisinzulin és GLP-1-receptoragonista új fix kombinációja

Contact Info

Product

Resources

About