Thread by @BevTchangMD

I usually tweet about #obesity but since I recently had a pt with type 2 #diabetes go from 100 units/d insulin to 0 with tirzepatide, this is a good time to review #insulin management when you start a GLP1 / GIP

#endocrine #endocrinology #research #clinicians
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SURPASS-5: tirzepatide + basal insulin vs. placebo

Method: If baseline A1c<8, ⬇️long acting insulin dose by 20% at start of study

Result: At end of study, insulin was ⬇️11% for 15-mg tirzepatide group vs. ⬆️75% for placebo

jamanetwork.com/journals/jama/…

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SUSTAIN-5: semaglutide 1.0 + basal insulin vs. placebo

Method: If baseline A1c<8, ⬇️long acting insulin dose by 20% at start of study

Result: At end of study, insulin ⬇️15% for 1-mg semaglutide group vs. ⬇️4% for placebo

academic.oup.com/jcem/article/1…

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SUSTAIN-11: semaglutide 1.0 + basal insulin vs. prandial insulin + basal insulin

Result: NO aspart in semaglutide arm vs. 37 units in aspart arm but A1c 7.0 (sema) vs. 7.3 (aspart)

Check out those diverging body #weight trajectories!

dom-pubs.onlinelibrary.wiley.com/doi/10.1111/do…

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a LEAD trial: liraglutide 1.8 + basal insulin vs. placebo

Method: If baseline A1c<8, ⬇️long acting insulin dose by 20% at start of study

Result: At end of study, insulin ⬇️13% for liraglutide group vs. ⬇️2% for placebo

dom-pubs.onlinelibrary.wiley.com/doi/10.1111/do…

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AWARD-4: dulaglutide 1.5 + basal insulin vs. prandial insulin + basal insulin

At weeks 26 and 52, total daily insulin ⬇️ 30% and daily prandial insulin dose ⬇️30% in dulaglutide arm vs. glargine arms

thelancet.com/journals/lance…

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TLDR:
If you're starting a GLP1 / GIP for a pt with #diabetes treated with insulin...
👉⬇️ Basal insulin by 20% if A1c<8
👉Basal insulin need will ~⬇️15%
👉Prandial insulin need will ~⬇️30%
👉Remember RCTs were conducted with lower doses of GLP1s than currently available

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