title: Lowest Glucose Variability and Hypoglycemia Are Observed With the Combination of a GLP-1 Receptor Agonist and Basal Insulin (VARIATION Study).
abstract: There is a dearth of published literature comparing glucose variability (GV) between different insulin regimens in type 2 diabetes. This cohort study compares GV using continuous glucose monitoring (CGM) in patients with well-controlled type 2 diabetes using four common insulin regimens: basal insulin + oral drugs (BO), basal insulin + glucagon-like peptide 1 receptor agonist (GLP-1 RA) (BGLP), premixed insulin (PM), and basal-bolus insulin (BB).
  
  
  
  Consecutive patients from three endocrinology clinics who met study criteria-type 2 diabetes, age 18 to 80 years, BMI ≤ 45 kg/m2, stable insulin regimen for a minimum of 6 months, and stable A1C value ≤7.5% (58 mmol/mol) before study enrollment-underwent 6-day masked CGM. Hypoglycemia was defined as a sensor glucose concentration <70 mg/dL on CGM.
  
  
  
  A total of 160 patients with comparable baseline characteristics formed four equal insulin regimen cohorts. The daily glucose SD (the primary outcome) was significantly lower in the BGLP cohort versus the BO, PM, and BB cohorts (P = 0.03, P = 0.01, and P < 0.01, respectively), and remained so after adjusting for age, BMI, type 2 diabetes duration, and A1C. Similarly, daily hypoglycemia outcomes on CGM were least for the BGLP cohort.
  
  
  
  The lowest GV and lowest hypoglycemia were observed in patients using the combination of basal insulin with a GLP-1 RA, supporting the complementary glycemic action of these agents in type 2 diabetes. These observed benefits in GV and hypoglycemia may contribute to the cardiovascular outcome reduction seen with GLP-1 RA therapy and should be investigated further.
authors.affiliation: LMC Diabetes & Endocrinology, Brampton, Ontario, Canada harpreet.bajaj@lmc.ca.|Leadership Sinai Center for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Harpreet S
authors.initials: HS
authors.lastname: Bajaj
authors.affiliation: LMC Diabetes & Endocrinology, Toronto, Ontario, Canada.
authors.forename: Karri
authors.initials: K
authors.lastname: Venn
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Chenglin
authors.initials: C
authors.lastname: Ye
authors.affiliation: LMC Diabetes & Endocrinology, Toronto, Ontario, Canada.
authors.forename: Avril
authors.initials: A
authors.lastname: Patrick
authors.affiliation: Royal College of Surgeons, Dublin, Ireland.
authors.forename: Shivani
authors.initials: S
authors.lastname: Kalra
authors.affiliation: LMC Diabetes & Endocrinology, Etobicoke, Ontario, Canada.
authors.forename: Hasnain
authors.initials: H
authors.lastname: Khandwala
authors.affiliation: LMC Diabetes & Endocrinology, Etobicoke, Ontario, Canada.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Aslam
authors.affiliation: LMC Diabetes & Endocrinology, Oakville, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Twum-Barima
authors.affiliation: LMC Diabetes & Endocrinology, Toronto, Ontario, Canada.
authors.forename: Ronnie
authors.initials: R
authors.lastname: Aronson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D023381:Endpoint Determination; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000097:blood / Q000494:pharmacology*; D015994:Incidence; D007328:Insulin / Q000097:blood / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D055815:Young Adult; D000097789:Glucagon-Like Peptide-1 Receptor Agonists
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D000097789:Glucagon-Like Peptide-1 Receptor Agonists