GLP-1 Agonists Now Approved for Use with Lantus and Levemir

Over the past several years, the use of GLP-1 drugs (such as Byetta and Victoza) together with basal insulins (such as Lantus and Levemir) as a treatment for type 2 diabetes has been a hot topic among healthcare providers. For several reasons, this combination therapy makes a lot of sense: 1) the weight loss provided by GLP-1 agonists can help reduce (or overcome) the weight gain associated with long-acting insulin therapy; and 2) GLP-1 agonists and basal insulins help improve blood glucose control in complementary ways. Basal insulins act over a long period of time at a constant rate to cover background (between meal) insulin needs. Meanwhile, GLP-1 agonists cause insulin secretion only when blood glucose levels are high, effectively lowering post-meal blood glucose spikes without increasing the risk for hypoglycemia. Last year, a study examining Byetta in combination with Lantus confirmed much of this thinking, as people with type 2 diabetes achieved greater reductions in A1c and experienced weight loss (instead of weight gain) with both therapies versus Lantus alone. Although the use of a mealtime insulin (such as Apidra, Humalog, or NovoLog) with a basal insulin attempts to accomplish the same exact goal, mealtime insulins typically cause weight gain and significantly higher rates of hypoglycemia (because their action is not dependent on blood glucose levels).

We were excited, then, to hear that two GLP-1 agonist and basal insulin therapy regimens were recently approved for use by people with type 2 diabetes. In the US, Byetta is now approved for use alongside Lantus, and in Europe, Victoza is approved for use with Levemir. Although we had learned through conversations with the diaTribe advisory board that the “off-label” use of GLP-1 agonists with basal insulins was quite common before these approvals were granted, we believe that Byetta and Victoza could become even more attractive alternatives to mealtime insulins as reimbursement improves (the combination had been rarely covered by insurance companies in the past) and healthcare provider familiarity with this combination use expands. There are also a number of other exciting GLP-1 agonist/basal insulin combination products in development (some of which may only be given in one shot per day!). For more information on these products as well as a more detailed account on the use of GLP-1 agonists with basal insulins, please see the New Now Next column in diaTribe issue #29. --BK