In diabetes mellitus, there are different therapeutic options that act at different levels in the pathogenesis of hyperglycemia, with the aim of facilitating good glycemic control of the patient, in addition to the other potential benefits of each particular molecule.
The importance of beta cell function in patients with long-term type 2 diabetes mellitus. In this type of patient, in addition to a GLP-1 analog (ArGLP-1) to optimize glycemic control, increase weight loss and obtain cardiovascular benefits, adding basal insulin should be considered when glycemic control is insufficient.
This option should be considered when the patient has experienced adverse effects from other treatments and good glycemic control does not result in monotherapy with ArGLP-1 or in combination with other drugs.
The advantages of using ArGLP-1 include, basically, the reduction of the risk of hypoglycemia, the weight gain associated with insulin therapy, the reduction of insulin requirements and the simplification of the complexity of administration. In addition to metabolic, cardiovascular and renal benefits.
the completion of the effect
It should be considered that the combination of basal insulin and ArGLP-1 complement each other. On the one hand, basal insulin intervenes for the patient to achieve the goal of fasting glycemia, and on the other hand, ArGLP-1 helps to reduce the postprandial excursion, inhibit gastric emptying, stimulate glucose-dependent insulin secretion, and suppress hyperglucagonemia. . In addition, the risk of hypoglycemia is lower with ArGLP-1 than with rapid bolus insulin.
The potential weight-loss effect of ArGLP-1 could counteract the weight-gain effect that often occurs with insulin treatment. The combination could lead to a lower insulin dose and thus a lower risk of hypoglycemia.
suboptimal control
Despite new pharmacological groups for the treatment of type 2 diabetes, glycemic control continues to be suboptimal and approximately half are still not adequately controlled.
In many cases, patients with poor metabolic control, with HbA1c > 8.0-8.5-9%, and obesity I/II degree are seen with one, two or three antidiabetic drugs: metformin, sulfonylureas and DPP-IV inhibitors, but without insulin and without ArGLP-1 , having a clear reason for the said medicines.
On average, patients with HbA1c levels above targets wait one year before intensive treatment is used. Failure to reach the HbA1c target on time does not increase the risk of long-term complications.
Cardiovascular risk
In patients with cardiovascular disease, where glycemic control goals are not met, ArGLP-1, with proven cardiovascular benefits, can be added to reduce cardiovascular risk and all-cause mortality.
A GLP-1 analog is proven to promote weight loss, thereby tipping the balance in favor of weight loss associated with insulin, which has the opposite effect of increasing the patient’s weight.
With the combination of GLP-I analogs and basal insulin, a reduction in the necessary doses of basal insulin and pandrial insulin was achieved.
Benefits
Thus, a mixed regimen of two drugs results in greater glycemic control, reducing the risk of hypoglycemia and insulin-associated weight gain. On the other hand, they delay gastric emptying with an anorexigenic effect, that is, hunger in the central nervous system. From all of these, it allows to balance the blood glucose when combined with the control of weight loss. It should be added that these molecules have shown cardiovascular and renal benefits.
For the preparation of this article, the collaboration of doctors Maria Vega Cornejo, Juan Carlos Nieto Rivas and Emilio Rato Alario, from the Algeciras Health Center; Noemi Brox Torrecilla, Teresa Ruiz Gracia and Beatriz Ugalde Abiega, from Hospital Ramón y Cajal, Madrid, and endocrinologists Soledad Librizzi, Irune Blanco, Gonzalo Allo, Inés Jiménez, Carmen Montañez and Myriam Lorena Partida, Madrid.
