COMPARING CLINICAL OUTCOMES AND COSTS FOR DIFFERENT TREATMENT INTENSIFICATION APPROACHES IN PATIENTS WITH TYPE 2 #DIABETES UNCONTROLLED ON BASAL INSULIN: ADDING #GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONISTS VS ADDING RAPID-ACTING INSULIN OR INCREASING BASAL INSULIN DOSE
http://journals.aace.com/doi/abs/10.4158/EP171769.OR?code=aace-site

Not all patients with type 2 diabetes achieve the recommended glycated hemoglobin A1c (A1C) levels after adequate titration of basal insulin (BI). Current intensification approaches include addition of rapid-acting insulin (RAI) or a glucagon-like peptide-1 receptor agonist (GLP-1 RA), but it is not clear which strategy results in better long-term outcomes

A total of 8,034 patients underwent treatment intensification within 6 months of showing poor glycemic control; 4,134 patients had their BI dose adjusted, and 2,076 and 331 received RAI and GLP-1 RA, respectively. A1C changes were similar for the GLP-1 RA and RAI cohorts, but higher for the GLP-1 RA vs the dose adjustment group. The hypoglycemia rate was lower after adding GLP-1 RA vs RAI or increasing BI dose. No overall changes in utilization of healthcare resources or diabetes-related costs were observed between intensification strategies, although prescription costs were higher for the GLP-1 RA cohort.

Conclusion—BI in combination with GLP-1 RAs appears to be an effective intensification strategy, further reducing A1C levels and hypoglycemia frequency compared to increasing BI doses GLP-1 RA addition also decreases hypoglycemia frequency vs BI dose increases and RAI addition, without raising overall healthcare costs

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Association Between Use of #Sodium-Glucose Cotransporter 2 Inhibitors, #Glucagon-like Peptide 1 Agonists, and Dipeptidyl Peptidase 4 Inhibitors With All-Cause Mortality in Patients With Type 2 #Diabetes

https://jamanetwork.com/journals/jama/fullarticle/2678616

SGLT-2 inhibitors (absolute RD, −0.8%; HR, 0.79 95% CrI, 0.69 to 0.91) and GLP-1 agonists (absolute RD, −0.5%; HR, 0.85 95% CrI, 0.77 to 0.94) were significantly associated with lower CV mortality than were the control groups. SGLT-2 inhibitors were significantly associated with lower rates of HF events (absolute RD, −1.1%; HR, 0.62 95% CrI, 0.54 to 0.72) and MI (absolute RD, −0.6%; HR, 0.86 95% CrI, 0.77 to 0.97) than were the control groups. GLP-1 agonists were associated with a higher risk of adverse events leading to trial withdrawal than were SGLT-2 inhibitors (absolute RD, 5.8%; HR, 1.80 95% CrI, 1.44 to 2.25) and DPP-4 inhibitors (absolute RD, 3.1%; HR, 1.93 95% CrI, 1.59 to 2.35).

Conclusions and Relevance In this network meta-analysis, the use of SGLT-2 inhibitors or GLP-1 agonists was associated with lower mortality than DPP-4 inhibitors or placebo or no treatment. Use of DPP-4 inhibitors was not associated with lower mortality than placebo or no treatment

#Glucagon blockade restores functional β-cell mass in type 1 #diabetic mice and enhances function of human islets
https://2medical.news/2021/03/05/glucagon-blockade-restores-functional-%CE%B2-cell-mass-in-type-1-diabetic-mice-and-enhances-function-of-human-islets/

Both type 1 and type 2 diabetes are associated with reduced β-cell mass or function, resulting from decreased proliferation and increased apoptosis. Understanding the signals governing β-cell survival and regeneration is critical for developing strategies to maintain healthy populations of these cells in individuals. Both forms of diabetes are associated with hyperglucagonemia and an increased plasma glucagon:insulin ratio. Glucagon excess contributes to metabolic dysregulation of …

Downregulation of the kidney #glucagon receptor, essential for #renal function and systemic homeostasis, contributes to chronic kidney disease

https://2medical.news/2024/02/26/downregulation-of-the-kidney-glucagon-receptor-essential-for-renal-function-and-systemic-homeostasis-contributes-to-chronic-kidney-disease/

#Glucagon-like peptide-1 receptor agonists and #stroke: A systematic review and meta-analysis of #cardiovascular outcome trials

https://2medical.news/2024/06/27/glucagon-like-peptide-1-receptor-agonists-and-stroke-a-systematic-review-and-meta-analysis-of-cardiovascular-outcome-trials/

Quantified Metrics of #Gastric Emptying Delay by #Glucagon-Like Peptide-1 Agonists: A Systematic Review and Meta-Analysis With Insights for Periprocedural Management

https://2medical.news/2024/07/31/quantified-metrics-of-gastric-emptying-delay-by-glucagon-like-peptide-1-agonists-a-systematic-review-and-meta-analysis-with-insights-for-periprocedural-management/