Once-daily prandial lixisenatide versus once-daily rapid-acting insulin in patients with type 2 diabetes mellitus insufficiently controlled with basal insulin: analysis of data from five randomized, controlled trials

AimsTo compare the efficacy and safety of lixisenatide (LIXI), a once-daily prandial glucagon-like peptide-1 (GLP-1) receptor agonist, as add-on to basal insulin (Basal + LIXI) versus once-daily rapid-acting insulin (Basal + RAI) in patients with type 2 diabetes mellitus (T2DM).MethodsData were extracted from five randomized controlled trials assessing the efficacy and safety of basal insulin + insulin glulisine (n = 3) or basal insulin + LIXI (n = 2). Patients in the Basal + LIXI cohort were matched to patients in the Basal + RAI cohort using propensity score matching.ResultsIn the matched population, Basal + LIXI was twice as likely to reach composite outcomes of glycated haemoglobin (HbA1c) < 7% and no symptomatic hypoglycaemia compared with the Basal + RAI group (odds ratio [OR]: 1.90; 95% confidence interval [CI]: 1.01, 3.55; P = 0.0455), as well as HbA1c < 7% and no severe hypoglycaemia (OR: 1.97; 95 CI: 1.06, 3.66; P = 0.0311). Furthermore, Basal + LIXI was more than twice as likely to reach HbA1c < 7%, no weight gain and no symptomatic hypoglycaemia (OR: 2.58; 95% CI: 1.23, 5.40; P = 0.0119).ConclusionsBoth basal + LIXI and Basal + RAI improved glycaemic control in patients with T2DM with inadequate glycaemic control on basal insulin. Basal + LIXI offers an effective therapeutic option to advance basal insulin therapy, improving glucose control without weight gain and with less risk of hypoglycaemia than prandial insulin.