Currently, the metabolic control of type 2 diabetes mellitus (T2DM) remains a great challenge. In my country, the blood glucose compliance rate of T2DM patients is only 49.4%. Oral antidiabetic drug therapy is a common initial regimen, but as diabetes progresses, oral antidiabetic drugs often fail to achieve durable glycemic control.
On March 5, 2022, the world’s first basal insulin GLP-1RA injection was officially launched in China, which is suitable for adults with type 2 diabetes mellitus with poor blood sugar control. The two hypoglycemic drugs are combined into one, the ingredients do not affect each other, and the efficacy and advantages are complementary, providing a new choice for diabetic patients with “high-standard, easy-to-control“.
Two into one, complementary mechanisms
In the “Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020) It has been proposed in the “Basic Insulin GLP-1RA Injection” that the therapeutic advantage of basal insulin GLP-1RA injection is that “under the condition of the same or lower insulin dose, the hypoglycemic effect is better than that of basal insulin, and it can reduce the risk of hypoglycemia and avoid the effects of insulin therapy. adverse effects such as weight gain.”
Basic insulin GLP-1RA injection is a compound preparation composed of basal insulin (degludec) and GLP-1RA (liraglutide). As an exogenous insulin supplement, basal insulin inhibits hepatic glycogenolysis and gluconeogenesis, reduces hepatic glucose output, increases skeletal muscle glucose uptake, and effectively controls fasting blood sugar. However, insulin has a strong hypoglycemic effect, but it is accompanied by Risk of hypoglycemia, as well as insulin resistance and weight gain. GLP-1 receptors are widely distributed in many organs or tissues in the body, including the central nervous system, gastrointestinal tract, cardiovascular system, liver, adipose tissue, muscle, etc. in addition to the pancreas. GLP-1RA can simulate natural GLP- 1 to activate GLP-1R and indirectly promote insulin secretion from pancreatic β cells. GLP-1RA is second only to insulin in hypoglycemic efficacy, but has a low risk of hypoglycemia, can enhance insulin sensitivity, and has concurrent weight loss, cardiovascular, and renal benefits.
Basic insulin GLP-1RA injection, through complementary mechanisms, not only ensures that patients with poor islet function can maintain stable basal blood glucose under the action of basal insulin, but also benefits from GLP-1RA’s lower blood sugar risk , effectively improve postprandial blood sugar control.
Efficacy and safety of basal insulin GLP-1RA
From the perspective of clinical evidence, basic The results of the DUAL series of the global phase 3 clinical trial of insulin GLP-1RA injection show that more patients can reach the glycated hemoglobin standard, significantly improve fasting and postprandial blood sugar control, and reduce the risk of hypoglycemia.
However, clinical studies have shown that hypoglycemia and gastrointestinal reactions may also occur after using this drug, so it is necessary to monitor blood sugar and adverse reactions when using it. Do not self-medicate, especially if the drug is a prescription drug. In addition, pregnant, lactating women and children do not have sufficient clinical experience, and it is not recommended for use; patients with mild and moderate renal insufficiency have limited experience, and no research has been done on patients with hepatic insufficiency, nor is it recommended for use.
Usage, dosage and precautions of basal insulin GLP-1RA injection
The injection device of basal insulin GLP-1RA injection is a 3ml pre-filled pen. 1 dose unit consists of 1IU of insulin degludec and 0.036mg of liraglutide, with a maximum daily dose of 50 dose units. Adults with type 2 diabetes mellitus with poor glycemic control can take the prescribed dose once daily by subcutaneous injection as prescribed by a physician. It can be administered at any time of the day, regardless of meal time, preferably at the same time every day. If it is not possible to administer at the same time every day, at least an 8-hour interval should be ensured between two injections.
Allergic to any one or two active ingredients of the injection or any of its excipients, patients with a family history of medullary thyroid cancer (MTC), or multiple endocrine neoplasia Basal insulin GLP-1RA injection is contraindicated in patients with type 2.
Summary
Basic insulin GLP-1RA injection is a breakthrough fusion of insulin degludec and The advantages of the two-component liraglutide maintain their respective pharmacological properties and hypoglycemic efficacy, and synergistically control glucose. Its listing in China provides sugar lovers with a more efficient, safe and convenient sugar control solution.
References:
1.Harris SB, etal. Diabetes Obes Metab. 2017 Jun;19(6):858-865.
2.Hong Tianpei.The hypoglycemic mechanism and clinical practice of IDegLira, a compound preparation of basal insulin and GLP-1RA[J].Drug Evaluation,2020,17(17):1-3+10.
3.Wang L, et al. JAMA. 2021, 326(24):2498-2506