An Evolving Role for Combinations of Injectable Antihyperglycemic Therapies

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Haymarket Medical Education

1.50 hours

PROGRAM DESCRIPTION
Despite recent signs of success in slowing the United States’ epidemic of type 2 diabetes mellitus (T2DM), many patients are not consistently meeting recommended targets for blood glucose levels.1,2 Poorly controlled T2DM continues to place tremendous burdens on affected individuals, their families, and health care systems.3-5 Over the two last decades, a better pathophysiologic understanding of the disease has spurred the development of new and expanding classes of antihyperglycemic medications.6-8 These include new long-acting basal insulin analogs with reduced hypoglycemia risks and several pleiotropic agonists of glucagon-like peptide-1 (GLP-1) receptors.9,10 These advances have naturally led to studies evaluating outcomes when T2DM is treated with multidrug regimens comprising agents from both injectable medication classes.11 In fact, two fixed-dose combination formulations are now available in the United States.12-14 With overall goals of improving glycemic control and reducing long-term risks among diverse populations of patients, this multimedia eHealth SourceTM activity focuses on the mechanistic rationale, clinical trial data for efficacy and safety, and the practical considerations for combining basal insulin analogs and GLP-1 receptor agonists to better manage T2DM antihyperglycemic medication classes.References1. Gregg EW. The changing tides of the type 2 diabetes epidemic—smooth sailing or troubled waters ahead? Kelly West Award Lecture 2016. Diabetes Care. 2017;40(10):1289-1297.2. Carls G, et al. Achievement of glycated hemoglobin goals in the US remains unchanged through 2014. Diabetes Ther. 2017;8(4):863-873.3. Liu J, et al. The burden of severe hypoglycemia in type 2 diabetes. Curr Med Res Opin. 2017:1-19.4. Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes. 2008;26(2):77-82.5. Chawla A, et al. Microvascular and macrovascular complications in diabetes mellitus: distinct or continuum? Indian J Endocrinol Metab. 2016;20(4):546-551.6. American Diabetes Association. Standards of Medical Care in Diabetes—2017. Diabetes Care. 2017;40(suppl 1):S1-S135.7. Defronzo RA. Banting Lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009;58(4):773-795.8. Garber AJ, et al. Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm—2017 Executive Summary. Endocr Pract. 2017;23(2):207-238.9. Ratner RE, et al. Hypoglycaemia risk with insulin degludec compared with insulin glargine in type 2 and type 1 diabetes: a pre-planned meta-analysis of phase 3 trials. Diabetes Obes Metab. 2013;15(2):175-184.10. Trujillo JM, et al. GLP-1 receptor agonists: a review of head-to-head clinical studies. Ther Adv Endocrinol Metab. 2015;6(1):19-28.11. Eng C, et al. Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis. Lancet. 2014;384(9961):2228-2234.12. Valentine V, et al. Rationale for, initiation and titration of the basal insulin/GLP-1RA fixed-ratio combination products, IDegLira and IGlarLixi, for the management of type 2 diabetes. Diabetes Ther. 2017;8(4):739-752.13. Linjawi S, et al. The efficacy of IDegLira (Insulin Degludec/Liraglutide Combination) in adults with type 2 diabetes inadequately controlled with a GLP-1 receptor agonist and oral therapy: DUAL III randomized clinical trial. Diabetes Ther. 2017;8(1):101-114.14. Rosenstock J, et al. Benefits of LixiLan, a titratable fixed-ratio combination of insulin glargine plus lixisenatide, versus insulin glargine and lixisenatide monocomponents in type 2 diabetes inadequately controlled on oral agents: The LixiLan-O randomized trial. Diabetes Care. 2016;39(11):2026-2035.

EDUCATIONAL OBJECTIVES
After completing this activity, the participant should be better able to:Describe the clinical rationale for combining insulin and incretin-based agents in the treatment of patients with T2DMDiscuss the clinical profiles and prescribing considerations for combinations of injectable antihyperglycemic agents in the management of T2DMIntensify antihyperglycemic regimens with injectable combination medications based on progress toward individualized glycemic targets, risks of hypoglycemia, and other patient-specific parametersEducate patients with T2DM to motivate lifestyle modifications, reduce hypoglycemia risks, and enhance treatment adherence