Gut hormone-drug combination therapy may help tackle type 2 diabetes

Scientists have revealed that a combined treatment with a drug that mimics the action of a gut hormone and basal insulin is more effective at improving blood sugar control than other anti-diabetic treatments.

According to the study, the treatment works with similar rates of hypoglycaemia (dangerously low blood sugar levels) and greater weight loss, a systematic review and meta-analysis.

Dr Ravi Retnakaran, lead author and endocrinologist at Mount Sinai Hospital, Toronto, Canada, said that achieving Achieving normal blood sugar levels in people with type 2 diabetes is compromised by the adverse side effects plaguing currently available treatments. Some anti-diabetic treatments increase risk of hypoglycaemia and weight gain which put patients at increased risk of heart attack and stroke, as well as reducing their quality of life.

Glucagon-like peptide-1 (GLP-1) is a hormone that is secreted from the gut after eating. GLP-1 based therapy was recently introduced as a new treatment for patients with type 2 diabetes because of its ability to regulate blood sugar levels and to generate weight loss as opposed to weight gain. Moreover, GLP-1 agonists only stimulate insulin secretion when blood glucose levels are high, without increasing risk of hypoglycaemia. However, their optimal role in the management of type 2 diabetes has yet to be established.

The analysis of 15 randomised trials involving more than 4300 participants showed that the combination of basal insulin with a GLP-1 agonist resulted in a 92 percent greater likelihood of achieving target blood sugar control (A1c of 7 percent or lower), with similar rates of hypoglycaemia and an average weight loss of more than 3kg compared with other anti-diabetic treatments. Compared to full basal-bolus insulin regimens, the combined treatment generated modestly better blood sugar control, but had a 33 percent lower risk of hypoglycaemia and almost 6kg greater weight loss.

Researchers said that combining a GLP-1 agonist with basal insulin is a treatment strategy that can achieve the ideal triumvirate of short-term outcomes in diabetes management: optimal glucose control alongside weight loss and a low risk of hypoglycaemic episodes. As such, this combination treatment could improve the management of people with type 2 diabetes.

The study was published in The Lancet.