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Insulin vs GLP-1 analogues in poorly controlled Type 2 diabetic subjects on oral therapy: A meta-analysis

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Abstract

Aim: To compare insulin and GLP-1 analogues therapy on glycemic control in poorly controlled Type 2 diabetes (T2DM) subjects failing on oral therapy. Methods: The electronic database PubMed was systematically searched for randomized controlled trial (RCT) with duration >16 weeks comparing the addition of insulin therapy vs glucagon-like peptide (GLP-1) analogues in poorly controlled T2DM subjects on oral therapy. Results: We identified 7 RCT with 2199 patients of whom 1119 were assigned to insulin therapy and 1080 received a GLP-1 analogue. Both insulin and GLP-1 analogues were effective in lowering glycated hemoglobin (HbA1c) with no statistically significant difference between the mean decreases in HbA1c. However, insulin was more effective than GLP-1 analogues in lowering the fasting plasma glucose concentration, while GLP-1 agonists were more effective in lowering the postprandial glucose concentration. Insulin therapy was associated with weight gain while GLP-1 analogues consistently caused weight loss and the difference between the mean change in body weight between the two therapies was highly statistically significant. Despite a similar decrease in HbA1c, the risk of hypoglycemia was 35% lower (p=0.001) with GLP-1 therapy compared to insulin. Compared to insulin, GLP-1 analogues caused a significant decrease in systolic blood pressure and were associated with greater rate of gastrointestinal adverse events. Conclusion/interpretation: In poorly controlled T2DM subjects on oral therapy, GLP-1 analogues and insulin are equally effective in lowering the HbA1c. However, GLP-1 analogues have additional non-glycemic benefits and lower risk of hypoglycemia. Thus, GLP-1 analogues should be considered as a treatment option in this group of diabetic individuals.

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Authors and Affiliations

  1. Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, USA

    M. A. Abdul-Ghani, K. Williams & R. A. DeFronzo

  2. Division of Diabetes, Department of Internal Medicine, Istanbul Medipol University, Istanbul, Turkey

    M. Kanat MD

  3. Department of Endocrinology and Metabolism, Sisli Etfal Training and Research Hospital, Istanbul, Turkey

    Y. Altuntas

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  1. M. A. Abdul-Ghani
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  2. K. Williams
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  3. M. Kanat MD
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  4. Y. Altuntas
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  5. R. A. DeFronzo
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Correspondence to M. Kanat MD.

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Abdul-Ghani, M.A., Williams, K., Kanat, M. et al. Insulin vs GLP-1 analogues in poorly controlled Type 2 diabetic subjects on oral therapy: A meta-analysis. J Endocrinol Invest 36, 168–173 (2013). https://doi.org/10.3275/8367

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