Endocrine Abstracts

Type 2 diabetes (T2DM) is a chronic and progressive disease associated with microvascular and macrovascular complications leading to increased morbidity and mortality. Insulin remains the cornerstone therapy for longer-duration T2DM and b-cell failure. Glucagon-like peptide-1 receptor agonists are a class of multifactorial T2DM medications that have been shown to improve numerous risk factors for diabetes-related complications, including glycemic control, reduction in body weight and a low risk of hypoglycaemia. Improvements in glycaemic control confer a reduced risk of long-term diabetes-related complications. We reported here a case that provides the efficacy and safety of once-weekly semaglutide vs once daily GLP-1 RAs in obese patient with T2DM inadequately controlled on insulin therapy (Insulin Aspart + OADs). Improvements in glycaemic control were greater with once-weekly semaglutide 1 mg than with once-daily liraglutide 1.8 mg, resulting in a longer time to treatment intensification with insulin therapy. Together with lifestyle modifications and physical activity we achieved better glycemic control without severe or blood glucose-confirmed symptomatic hypoglycemia (plasma glucose level below 3.1 mmol/l), HbA1c, FPG, and body weight in patient who is receiving insulin therapy. Also with this therapy we achieved reduction in his lipoprotein metabolism because he could not tolerate any statins. Overall, the case presented here summarized the benefit of once-weekly semaglutide 1.0 mg as an add-on to insulin therapy as the most efficacious GLP-1 RA in terms of further reductions in HbA1c, body weight, BMI in patient with T2DM, insulin therapy and GLP-1RA injections. The reasons for switching to semaglutide from liraglutide included a need to reduce HbA1c or weight further, decreased frequency of administration and cardiovascular protection.

Keywords: Type 2 diabetes, obesity insulin therapy, GLP 1 RAs, lifestyle modifications