Access to Therapeutic Combinations in Type 2 Diabetes

Mark Warren, MD: Combinations of GLP-1 and insulin are very convenient for our patients. Usually, we get to this situation where they require 1 of 2 routes. They’re starting a GLP-1 receptor agonist earlier on, and eventually they fail that and need some basal insulin. Then you will add a basal insulin, and you can do that with a second injection or as a combination with 1 shot of these newer products. The combination offers a lot of convenience and less financial constraints for the patient with one copay. Anything that brings more convenience to the patient is good. The other way that we’ll sometimes get to a combination of insulin and GLP-1 receptor agonists is if they’re on a basal insulin and they’re not on a GLP-1 receptor agonist, we know we need to add one if they’re under 50 to 60 units of a basal insulin. That’s where I would like to go ahead and add a GLP-1 receptor agonist. And now, with the new combinations of a GLP-1 receptor agonist and basal insulin, this option is offered in just 1 convenient shot for our patients.

With the introduction of the combination GLP-1 receptor agonists and basal insulin, we do have an option to make it more convenient. So, my experience is that—when I want to add a GLP-1 receptor agonist to a basal insulin—this is really what I would prefer to go with, the combination. It makes things so much easier for the patient, so much easier for us to titrate just 1 drug. They don’t have to check their blood sugar, except for fasting and titrating to the fasting blood sugar. For us, it’s been very helpful to have these newer agents in combination.

The combination GLP-1 receptor agonist and long-acting insulin allows us to titrate more easily, and we start with a low dose and work our way up. That seems to be helpful in patients in mitigating the side effect profile of the GLP-1 receptor agonist, specifically the nausea. So, our nausea rates are much less than we’d expect with just adding a GLP-1 receptor agonist. The combination allows us to have more tolerability for the agents.

Formulary access for the combination GLP-1 receptor agonist and basal insulin is very important for us, because I think that this combination gives a lot of opportunities for simplifying one’s regimen, having better compliance of the patient, and gaining better glycemic control. Instead of taking multiple shots of maybe a basal and bolus insulin, taking 1 shot of a combination allows patients to get better compliance with just 1 shot. That’s very important for the patient.
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