(Source: US News & World Report 2014-09-12）
Combining insulin with a relatively new hormone-like drug appears to be a safer and more effective way to treat type 2 diabetes than current methods, a new review suggests.
The drug belongs to a new class of injectable medications called “glucagon-like peptide-1 agonists” (GLP-1), which mimic the behavior of a gut hormone. Its already available as a treatment for diabetes, either used alone or in combination with basal insulin.
But researchers say the current analysis is the first to confirm its superiority as part of a combined intervention.
“The cornerstone of type 2 diabetes management is to try to get blood sugar levels as normal as possible,” explained study author Dr. Ravi Retnakaran, an endocrinologist at Mount Sinai Hospital in Toronto. “Unfortunately, we have a lot of trouble getting there in most patients, because of the limitations and side effects of most therapies.”
As blood sugar levels get closer to normal, the risk for dangerously low blood sugar and weight gain rises. Such developments can boost the risk for cardiovascular complications, a common problem for people with diabetes.
This analysis, Retnakaran said, shows clearly that this combination therapy can achieve whats called the “ideal trifecta” in diabetes treatment: excellent control of blood sugar levels, without any increased risk for low blood sugar or weight gain.
The findings are published in the Sept. 12 issue of The Lancet.
To assess the combination therapys potential, the authors reviewed the findings of 15 previously conducted studies involving more than 4,300 diabetes patients. Those investigations were published between 2011 and 2014.
The result: When compared with a wide range of standard diabetes treatments, the combination therapy proved to be 92 percent more effective overall at achieving optimal blood sugar control, the researchers said.
Moreover, the risk for low blood sugar was no greater among combined-therapy patients than among those getting other standard therapies. And instead of gaining weight, combination-therapy patients lost pounds during treatment. On average, weight loss amounted to nearly seven pounds.
The team also conducted a head-to-head comparison between the combination therapy and so-called “full basal-bolus insulin” treatment. The latter approach involves a revolving regimen of short- and longer-acting forms of insulin.
In this case, the authors determined that the combination treatment achieved only “modestly” better blood sugar control. Yet the combination treatment was linked to a 33 percent lower risk for low blood sugars, and a weight-loss average of roughly 13 pounds.
Retnakaran said theres always the possibility that insulin or GLP-1 could prove problematic for individual patients. However, he stressed that as a whole there is no identifiable group or type of diabetes patient for whom the combination therapy would not theoretically be a viable option.
“And there are approved combinations of this sort on the market already,” he noted. “So this is just giving evidence that this is definitely an available therapy that should be considered.”
Dr. John Buse, chief of endocrinology at the University of North Carolina School of Medicine in Chapel Hill, N.C., agreed.
“I think this is a huge step forward,” he said. “They very clearly demonstrate a substantial benefit resulting from the use of this combination.”
Going forward, “the question becomes how early would it make sense to start using this intervention,” said Buse, author of an accompanying journal editorial.
“I believe it should certainly be the standard of care for patients who have been undergoing long-term treatment,” he said. “But diabetes is a chronic and progressively degenerative disease, for which the drugs we initially give ultimately fail, and more drugs have to be added over time.”
Buse said if this combination really is as well-tolerated as it seems, it might be advisable to start patients early on with this approach. “And then we wont have anything but success,” he said. “But that remains to be seen.”
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