Insulin requirements after switching from GLP-1 receptor agonist to dual GIP/GLP-1 receptor agonist in patients with type 2 diabetes mellitus.

IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY
Pharmacotherapy Pub Date : 2025-03-19 DOI:10.1002/phar.70009
Alexa M Lahey, Karolyn Duprey, Riley C Montague, Aric D Schadler, Kristina W Naseman
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引用次数: 0

Abstract

Introduction: With recent clinical implementation of tirzepatide, patients with type 2 diabetes mellitus (T2DM) are transitioning from glucagon-like peptide 1 receptor agonists (GLP-1 RA) to a dual gastric inhibitory polypeptide (GIP)/GLP-1 RA-like tirzepatide. Limited literature is available for insulin dose adjustments for patients concurrently using insulin during this transition. In clinical trials, tirzepatide has shown greater glycated hemoglobin (A1c) reduction and glucose-lowering effects compared to GLP-1 RAs, such as semaglutide, suggesting a potential elevated risk of hypoglycemia without proactive insulin adjustments.

Objectives: The primary objective of this study was to assess the percent change in daily insulin requirements 6 months after transitioning patients from GLP-1 RAs to tirzepatide.

Methods: This retrospective cohort study includes patients with T2DM who transitioned from a GLP-1 RA to tirzepatide while concurrently using insulin therapy. Patient-reported doses of insulin and study medications were collected by chart review by investigators, along with baseline demographics and adverse effects as additional endpoints.

Results: Sixty-six patients were included. The median insulin dose reduced from 101 units at baseline to 71 units after 6 months, with a median decrease of 9.5 units (p < 0.001). The median percent change in insulin dose was -9.2%. Patients with a baseline A1c of 8.0% or lower required a larger decrease in insulin compared to patients with a higher baseline A1c (-22.6% vs. 0%, p = 0.018). The intensity of GLP-1 RA and tirzepatide, determined by agent and dose, did not show a difference in insulin requirements (p = 0.279 and p = 0.317, respectively). Hypoglycemia occurred in eight patients (12.1%).

Conclusion: Patients require a reduction in insulin when transitioning from GLP-1 RAs to tirzepatide, especially if baseline A1c is less than or equal to 8.0%. Larger, comparative studies need to be performed to provide specific recommendations for various doses and product types of incretin receptor agonists.

2型糖尿病患者从GLP-1受体激动剂转换为双GIP/GLP-1受体激动剂后的胰岛素需求
简介:随着替西肽的临床应用,2型糖尿病(T2DM)患者正从胰高血糖素样肽1受体激动剂(GLP-1 RA)过渡到双胃抑制多肽(GIP)/GLP-1 RA样替西肽。有限的文献可用于胰岛素剂量调整的患者同时使用胰岛素在这一转变。在临床试验中,与semaglutide等GLP-1 RAs相比,替西帕肽显示出更大的糖化血红蛋白(A1c)降低和降糖作用,这表明如果不主动调节胰岛素,可能会增加低血糖的风险。目的:本研究的主要目的是评估患者从GLP-1 RAs转向替西肽后6个月每日胰岛素需要量的百分比变化。方法:这项回顾性队列研究包括T2DM患者,从GLP-1 RA过渡到替西肽,同时使用胰岛素治疗。研究人员通过图表审查收集患者报告的胰岛素和研究药物剂量,以及基线人口统计学和不良反应作为附加终点。结果:纳入66例患者。6个月后,中位胰岛素剂量从基线时的101个单位减少到71个单位,中位减少了9.5个单位(p)。结论:从GLP-1 RAs转向替西肽时,患者需要降低胰岛素剂量,特别是当基线A1c小于或等于8.0%时。需要进行更大规模的比较研究,为肠促胰岛素受体激动剂的不同剂量和产品类型提供具体建议。
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来源期刊
Pharmacotherapy
Pharmacotherapy 医学-药学
CiteScore
7.80
自引率
2.40%
发文量
93
审稿时长
4-8 weeks
期刊介绍: Pharmacotherapy is devoted to publication of original research articles on all aspects of human pharmacology and review articles on drugs and drug therapy. The Editors and Editorial Board invite original research reports on pharmacokinetic, bioavailability, and drug interaction studies, clinical trials, investigations of specific pharmacological properties of drugs, and related topics.
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