Medical guidelines include glucagon-like peptide-1 (GLP-1) receptor agonists as an option for glycemic control3,4
American Diabetes Association (ADA)
- If basal insulin has been titrated to an acceptable fasting blood glucose level, but A1C remains above target, consider advancing to combination injectable therapy to cover postprandial glucose excursions. Options include adding a GLP-1 RA or mealtime insulin, consisting of 1 to 3 injections of rapid-acting insulin analog (lispro, aspart, or glulisine) administered just before eating2
American Association of Clinical Endocrinologists (AACE)
- In patients who fail to achieve glycemic control with basal (long-acting) insulin, the AACE recommends treatment intensification for prandial control using non-insulin therapy such as a GLP-1 RA, SGLT-2 inhibitor or DPP-4 inhibitor, or treatment with prandial insulin3
2015 ADA recommendations for GLP-1 RA therapy4
- Adapted from Inzucchi et al.
- American Diabetes Association, Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach; Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes, American Diabetes Association, 2015. Copyright and all rights reserved. Material from this publication has been used with the permission of American Diabetes Association.
- Abbreviations: GI, gastrointestinal; GLP-1-RA, glucagon-like peptide-1 receptor agonist; Hypo, hypoglycemia; SGLT2-I, sodium-glucose cotransporter 2 inhibitor; SU, sulfonylurea; TZD, thiazolidinedione.
- *Consider starting at this stage when A1C is ≥9%.
- †Consider starting at this stage when blood glucose is ≥300 to 350 mg/dL (16.7-19.4 mmol/L) and/or A1C is ≥10% to 12%, especially if symptomatic or catabolic features are present, in which case basal insulin plus mealtime insulin is the preferred initial regimen.
- ‡Usually a basal insulin (Neutral Protamine Hagedorn, glargine, detemir, degludec).
aAdult patients with type 2 diabetes treated with metformin, sulfonylurea, or both were administered a single dose of BYETTA (mean dose, 7.8 mcg based on body weight) by subcutaneous injection.
Following a standardized meal, BYETTA reduced elevated PPG excursions to a nearly flat profile in patients with type 2 diabetes.
Select Important Safety Information: Warnings and Precautions
- Never Share a BYETTA Pen Between Patients: Pen-sharing poses a risk for transmission of blood-borne pathogens, even if the needle is changed.
- Pancreatitis: Based on postmarketing data BYETTA has been associated with acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis. After initiation and dose increases of BYETTA, observe patients carefully for pancreatitis (including persistent severe abdominal pain, sometimes radiating to the back, with or without vomiting). If pancreatitis is suspected, BYETTA should be discontinued promptly and should not be restarted if pancreatitis is confirmed.
- Hypoglycemia: Increased risk of hypoglycemia when used in combination with a sulfonylurea (SU) or when used with a glucose-independent insulin secretagogues (eg, meglitinides). Clinicians may consider reducing the SU dose in patients receiving BYETTA to reduce the risk of hypoglycemia. When used with insulin, evaluate and consider reducing the insulin dose in patients at increased risk of hypoglycemia.