title: A prospective study of concomitant GLP-1 analogue and insulin use in type 2 diabetes in clinical practice.
abstract: BACKGROUND
  A small number of studies have shown a significant reduction in HbA1c, weight and total daily insulin dose when a glucagon-like-peptide-1 (GLP-1) analogue was added in type 2 diabetes patients already on insulin treatment. Therefore, in a clinical setting, we investigated the effect of adding GLP-1 analogues in patients with type 2 diabetes already using insulin with respect to glycaemic control, body weight and insulin dose.
  
  
  METHODS
  In this prospective hospital-based study, we included 125 patients suffering from type 2 diabetes, treated with insulin and with a body mass index ≥ 35 kg/m2, who had started on GLP-1 analogues (liraglutide/exenatide). HbA1c, body weight, daily insulin dose, and side effects were registered at baseline, and after three, six and 12 months.
  
  
  RESULTS
  HbA1c and weight decreased significantly at all the timepoints (p ≤ 0.001 compared with baseline; HbA1c: -5.5 mmol/mol (-0.5%) and weight: -14.3 kg after 12 months), with the largest decrease in the first three months. No significant correlation was found between weight loss and HbA1c reduction, and between duration of diabetes and both weight loss and HbA1c reduction. After six and 12 months, the total daily insulin dose decreased significantly (p < 0.001, -75.4 IU after 12 months). Moreover, 34% of the patients were able to stop using insulin therapy after 12 months.
  
  
  CONCLUSIONS
  By adding a GLP-1 analogue in obese patients with type 2 diabetes already on insulin therapy, a significant reduction of HbA1c levels and body weight, and a significant reduction in insulin dose or complete discontinuation of insulin can be achieved.
authors.affiliation: Department of Internal Medicine and Diabetes Center, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
authors.forename: E F S
authors.initials: EF
authors.lastname: van Velsen
authors.forename: J
authors.initials: J
authors.lastname: Lamers
authors.forename: V
authors.initials: V
authors.lastname: Blok
authors.forename: R J M
authors.initials: RJ
authors.lastname: van Leendert
authors.forename: R M
authors.initials: RM
authors.lastname: Kiewiet-Kemper
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D000077270:Exenatide; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000031:analogs & derivatives / Q000494:pharmacology; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D000069450:Liraglutide / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009765:Obesity; D010455:Peptides / Q000627:therapeutic use*; D011446:Prospective Studies; D014688:Venoms / Q000627:therapeutic use*; D015431:Weight Loss / Q000187:drug effects; D055815:Young Adult
chemical_list: D000077270:Exenatide; D052216:Glucagon-Like Peptide 1; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D000069450:Liraglutide; D010455:Peptides; D014688:Venoms; C517652:hemoglobin A1c protein, human