IGlarLixi represents a better choice compared to biphasic insulin when intensifying basal insulin therapy

Authors: Emil Martinka
Authors‘ workplace: Národný endokrinologický a diabetologický ústav, n. o., Ľubochňa
Published in: Forum Diab 2021; 10(3): 201-206


Intensification of basal insulin treatment by switching to biphasic insulin is an effective treatment, but at the expense of weight gain and an increased risk of hypoglycemia. In addition, glycemic control targets with biphasic insulin are only achieved in a limited proportion of patients. Currently, the preferred method of intensification is to switch to a fixed combination of basal insulin and a GLP-1 receptor agonist such as the combination of insulin glargin and the GLP-1 receptor agonist lixisenatide (IGlarLixi). Previous comparisons of biphasic insulin versus IGlarLixi fixed combination treatment have relied only on indirect comparisons that have shown that IGlarLixi associates with better efficacy and safety profile compared to the biphasic insulin regimen, with higher HbA1c reduction, lower risk of hypoglycemia and weight gain, and that IGlarLixi offers a simpler once-daily treatment regimen without the need for intensive self-monitoring, thus contributing to improved quality of life and adherence to treatment. Recently, the results of the first “head-to-head” RCT study SOLIMIX comparing the titratable fixed combination IGlarLixi with biphasic insulin BIAsp 30 were also presented. The results of SOLIMIX showed better efficacy and safety of IGlarLixi compared to biphasic insulin. IGlarLixi demonstrated non-inferiority over BIAsp 30 in HbA1c change and subsequent hierarchical testing demonstrated superiority of IGlarLixi in reducing HbA1c over BIAsp 30. IGlarLixi also demonstrated superiority over BIAsp 30 in weight change. During treatment, a lower incidence of hypoglycemia as well as a lower number of hypoglycemia was observed in the IGlarLixi group compared to the BIAsp 30 group. At the same time, achieving the goal for HbA1c without weight gain and without hypoglycemia was significantly more common with IGlarLixi than with BIAsp 30. The results of the studies so clearly demonstrate medical benefits and justify a preference for a fixed combination basal insulin treatment.


basal insulin – intensification – IGlarLixi – biphasic insulin


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