ECE2023 Poster Presentations Diabetes, Obesity, Metabolism and Nutrition (159 abstracts)
The dual GIP/GLP-1 receptor co-agonist Tirzepatide vs GLP-1 receptor agonists as add-on to basal insulin in uncontrolled type 2 diabetes mellitus: A rapid review of randomized controlled trials and meta-analysis
Giuseppe Lisco 1 , Anna De Tullio 1 , Olga Disoteo 2 , Vincenzo De Geronimo 3 , Giuseppina Piazzolla 1 , Giovanni De Pergola 4 , Vito Angelo Giagulli 1 , Emilio Jirillo 1 , Edoardo Guastamacchia 1 , Carlo Sabbà 1 & Vincenzo Triggiani 1
1University of Bari “Aldo Moro”, Interdisciplinary Department of Medicine - Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, Bari, Italy; 2Grande Ospedale Metropolitano Niguarda, Diabetology Unit, Milan, Italy; 3Policlinico Morgagni CCD, 95125 Catania, Italy., Unit of Endocrinology, Catania, Italy; 4National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Unit of Geriatrics and Internal Medicine, Castellana Grotte (BA), Italy
Tirzepatide, a once-weekly dual co-agonist of Glucose-Dependent Insulinotropic Polypeptide (GIP) and Glucagon-Like Peptide 1 (GLP-1) receptors, has been demonstrated to improve glucose control and reduced body weight in different therapeutic approaches. With this rapid review and meta-analysis, we systematically reviewed the efficacy and safety of injectable incretin-based therapy added to basal insulin compared to basal insulin plus background treatments titrated rigorously to target fasting glycemia. The results were reviewed considering data from the SURPASS-5 trial, which demonstrated that Tirzepatide, in add-on to basal insulin, significantly improves several glycemic and extra glycemic endpoints. Eleven randomized clinical trials were identified and included in the meta-analysis. GLP-1 receptor agonists (GLP-1RAs) or Tirzepatide added to basal insulin than rigorously titrated basal insulin significantly ameliorates glucose control (Δ HbA1c = -1%, 95% CI -1.25; -0.74, I2 94%; Δ FPG = -14.6 mg/dl, 95% CI -21.6-; -7.6, I2 90%). Moreover, the chance to achieve optimal glucose control (i.e., HbA1c <7%) is significantly higher in the former treatment (RR 2.62, 95% CI 2.10; 3.26, I2 89%). GLP-1RAs or Tirzepatide added to basal insulin than rigorously titrated basal insulin significantly reduces body weight significantly (Δ weight = -3.95 kg, 95% CI -5.1, -2.79, I2 96%) without affecting the risk of hypoglycemia (Rr=1.01, 95% CI 0.86; 1.18, I2 7.7%). More precisely, Tirzepatide provides an impressive weight loss in a dose-dependent manner (-7.6 kg with Tirzepatide 5 mg/week, and -12.6 kg with 15 mg/week), exceeding the weight loss observed with GLP-1RAs. Injectable incretin-based therapy plus basal insulin remains a potent and safe therapeutic approach in uncontrolled type 2 diabetes previously treated with basal insulin. Thanks to a potent antihyperglycemic effect and an impressive induction of weight loss, Tirzepatide is expected to ameliorate the management of “diabesity” in these usually difficult-to-treat patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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