Glucagon-like peptide-1 receptor agonists, selection within the class. The rational combination of insulin glargine 100 + lixisenatide
Type 2 diabetes mellitus (T2DM) is a progressive disease accompanied by a gradual worsening of β-cell function. With a long course of T2DM, a significant proportion of patients develop absolute insulinopenia and there is a need to transfer the patient from oral hypoglycemic drugs (OHD) to basal insulin therapy in combination with OHD or to the basal-bolus regimen of insulin therapy (IT). More than 80% of patients with T2DM are obese or overweight and the addition of insulin, which is a lipogenetic hormone, to the therapy contributes to even greater weight gain, which serves as a prerequisite for increasing cardiovascular risks, as well as the appearance and progression of biomechanical problems such as arthrosis of the joints, venous insufficiency. In this review article, we will consider and evaluate the benefits of administering combinations of basal insulin glargine in combination with glucagonlike peptide-1 receptor agonists (GLP-1ra) lixisenatide to one of the most rational treatment regimens for patients with T2DM insulin deficiency and persistent insulin resistance. Also, the article focuses on the variability of glycemia, which according to research can play an important role in the pathogenesis of atherosclerosis and can be an independent risk factor for cardiovascular complications in patients with diabetes. Due to the fact that glycemic control is based on the determination of predominantly glycated hemoglobin (HbA1c) as a measure of average glucose concentration, it is known that this marker does not accurately reflect glycemic variability, which is characterized by the amplitude, frequency and duration of hypo- and hyperglycemic fluctuations. A fixed combination of insulin preparations glargin 100 and GLP-1ra lixisenatide allows to select individually effective dosage for a patient with type 2 diabetes and obesity, will help to achieve several goals at the same time - from improving glycemic parameters without increasing body weight and without increasing the risk of hypoglycemia, to significantly reduce the need for insulin with its previous use, as well as reduce the risk of cardiovascular complications.