Despite insulin being the most effective blood glucose lowering agent for patients with type 2 diabetes, more than half of these patients on basal insulin are not achieving glycemic targets. Further therapeutic intensification with prandial insulin presents increased risks of weight gain and hypoglycemia, as well as increased therapeutic complexity. The combination of a glucagon-like peptide 1 receptor agonist (GLP-1 RA) with basal insulin, especially in a once-daily fixed-ratio combination can provide better glycemic control with fewer adverse effects compared to increasing the basal insulin dosage or adding a prandial insulin.
Sonja Reichert, MD, MSc, CCFP
Stewart Harris, MD, MPH, FCFP, FACPM