Insulin dose adjustments with add-on glucagon-like peptide-1 receptor (GLP-1R) agonists in clinical practice

Figures & data

Table 1. Changes in insulin dose depending on baseline insulin regimen.

	Reference	Dose (U) at baseline		Maintenance dose (U)		Δ (%) to baseline (U)
Insulin scheme		Basal	Prandial	Basal	Prandial	Basal	Prandial
Basal	Arnolds et al. [23]	40.3		41.1		0.8 (+2%)
Basal/ bolus	N/A
OAD + Basal	Buse et al. [7]	49.5		62.5		13 (+26%)
	Levin et al. [6]	0.37 U/Kg	0.32 U/kg	0.47 U/kg	0.6 U/kg	0.1 U/kg (+27%)	0.6 U/kg (+88%)
	Phillips et al. [25]	105		97		8 (-8%)
	Seino et al. [17]	24.9		23.5		1.4 (-6%)
	Riddle et al. (Get Goal L) [15]	54		50		4 (-7%)
	Riddle et al. (Get Goal Duo 1) [16]	43.4		46.7		3.3 (+8%)
OAD + Basal/ bolus	Viswanathan et al. [24]	58.4	50.4	53.1	36.6	5.3 (-9%)	13.8 (-27%)
Pre-mixed	Viswanathan et al. [24]	72.9		28.3		44.6 (-61%)
Various insulin schemes ± OAD	Yoon et al. [2]	62.9	29.4	58.4	13	4.5 (-7%)	16.4 (-56%)
	Sheffield et al. [4]	48	26	49	17	1 (+2%)	9 (-35%)
	Lind et al. [13]	109.5		62.5		47 (-42%)
	Thong et al. [1]	120		78		42 (-35%)
	Nayak et al. [3]	144		55		89 (-62%)
	Rachabattula et al. [26]	135		114		21 (-16%)
	Anholm et al. [11]	69		41		28 (-40%)
AVERAGE		75.8	35.3	57.3	22.2	-20.8 (17%)	-13.1 (39.3%)

OAD: Oral antidiabetic drugs.

Table 2. Glycaemic control with different GLP-1-RAs added-on insulin.

GLP-1R agonist		Baseline values		Outcome values		Δ (% to baseline)
		HbA1c(%)	FPG (mmol/l)	HbA1c (%)	FPG (mmol/l)	HbA1c (%)	FPG (mmol/l)
Exenatide b.i.d.	Arnolds et al. [23]	8.1	5.6	6.3	4.3	1.8 (-22%)	1.3 (-23%)
	Riddle et al. [16,31]	7.8		6.5		1.3 (-17%)
	Buse et al. [7]	8.3	8.1	6.6	6.5	1.7 (-20%)	1.6 (-20%)
	Thong et al. [1]	9.5		9		0.5 (-5%)
	Pawasakar et al. [27]	8.5		8.1		0.4 (-5%)
	Levin et al. [6]	8.8		7.6		1.2 (-14%)
	Sheffield et al. [4]	8.4		7.5		0.9 (-11%)
	Yoon et al. [2]	8.1		7.5		0.6 (-7%)
	Nayak et al. [3]	8.8		8.6		0.2 (-2%)
	Viswanathan et al. [24]	7.7		7.1		0.6 (-8%)
	Christofides et al. [28]	8.1		7.3		0.8 (-10%)
	Phillips et al. [25]	8.2		6.8		1.4 (-17%)
	Houser et al. [29]	8.1		6.9		1.2 (-15%)
	Vithian et al. [30]	8.9		8.2		0.7 (-8%)
	Rachabattula et al. [26]	9.4		8.1		1.3 (-14%)
Exenatide LAR	N/A
Liraglutide	Anholm et al. [11]	8.6		7.8		0.8 (-9%)
Lixisenatide	Riddle et al. [14](Get Goal-L) [10]	8.4	8.1	7.8	8	0.6 (-7%)	0.1 (-1%)

b.i.d.: Twice daily; FPG: Fasting plasma glucose; HbA1c: Glycosylated haemoglobin; LAR: Long-acting release.

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