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GLP1-RA Add-on Therapy in Patients with Type 2 Diabetes Currently on a Bolus Containing Insulin


Incretin based therapies (IBT) continue to grow in popularity as a preferred treatment option for people with type 2 diabetes (T2D). Glucagon-like peptide-1 (GLP-1) and gastroinhibitory intestinal peptide constitutes >90% of all the incretin function. At diagnosis, therapy with pioglitazone/metformin (15 mg/850 mg/day) and liraglutide 0.6 mg/day was started based on the protocol at the center where she was treated (1). The news does, however, mark a major moment for type 2 diabetes: Xultophy is now the first ever basal insulin/GLP-1 analogue combination to gain regulatory clearance – for years we have heard nothing but enthusiasm about combining these two classes. It is available by prescription for people with Type 2 diabetes who are not on insulin. The level of the GLP-1 mRNA was evaluated by RT-PCR 24 h after transfection. Although intensive, sustained glycemic control may constitute one means of potentially reducing the risk of microvascular and macrovascular disease, multiple other strategies provide more-vigorous cardiac risk reduction, including aggressive blood pressure control and treatment of dyslipidemia.

The fastest growing segment of the diabetes market is the class of GLP-1 single-agonist therapies. Dr Jensen, who has practiced for the past 18 years as a nurse practitioner at Outpatient Primary Care Clinics in the Salt Lake VA Health Care System and is currently an assistant professor at the University of Utah College of Nursing, explained that each state has its own standard regarding the role of APRNs in the VA system. This molecule is the second generation from our path-finder molecule TTP054, and it is anticipated to provide excellent glycemic control and an attractive safety profile for the treatment of type 2 diabetes. Data support the use of GLP-1 RAs added to insulin regimens already containing bolus insulin for glycemic control, weight loss, and reduction or discontinuation of bolus insulin.

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[ Nutrition ]

GLP1-RA Add-on Therapy in Patients with Type 2 Diabetes Currently on a Bolus Containing Insulin


Gastric inhibitory polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) are the two primary incretin hormones secreted from the intestine upon ingestion of glucose or nutrients to stimulate insulin secretion from pancreatic β cells. Glucagon-like peptide-1 (GLP1) is a peptide hormone secreted by the intestinal L cells in response to food ingestion. Glucagon-like peptide-1 (GLP-1) receptor agonists represent a unique approach to the treatment of diabetes, with benefits extending outside glucose control, including positive effects on weight, blood pressure, cholesterol levels, and beta-cell function. GLP1 analogs (e.g., exenatide, liraglutide, dulaglutide, and albiglutide), which are approved as treatments for type 2 diabetes, mimic the effect of GLP1 to enhance insulin secretion. HbA1c, weight, BP, cholesterol, HDL, ALT, AST:ALT ratio, and eGFR change at 6–18 months were compared to baseline. The mean net change [95% confidence interval (CIs)] for HbA1c, weight loss and FPG for patients treated with GLP-1 RA as compared with insulin was -0.14% (-2 mmol/mol) [95% CI; (-0.27, -0.02)%; p = 0.03]; -4.40 kg [95% CI; (-5.23, -3.56) kg; p < 0.01] and 1.18 mmol/l [95% CI; (0.43, 1.93) mmol/l; p < 0.01], respectively, with negative values favouring GLP-1 and positive values favouring insulin. Zeer tevreden ‘Ik heb op dit moment rond de dertig mensen die GLP-1 therapie gebruiken. No glp1r-fluorescence was observed in ventricular cardiomyocytes. Schwartz and DeFronzo provide an opinion that now is the time to consider GLP-1 receptor agonists as a logical consideration for inpatient glycemic control. Nausea was identified in 7–42% of participants using GLP-1 RAs with insulin. Data support the use of GLP-1 RAs added to insulin regimens already containing bolus insulin for glycemic control, weight loss, and reduction or discontinuation of bolus insulin.

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