Two New Combination Injectable Drugs for Type 2 Diabetes Coming to Market

The US Food and Drug Administration (FDA) has approved two new combination injectable drugs that should be coming out on the market in the next few months. Both are combinations of insulin plus a GLP-1 receptor agonist. One is a combination of glargine and lixisenatide, which I am going to call LixiLan. The other is a combination of degludec and liraglutide, which I am going to call IDegLira. Those were the names that were used in the research studies for these two agents.^[1,2,3,4,5]

This may seem confusing, but the theory behind this is that type 2 diabetes is a disease of both insulin deficiency and insulin resistance—and a whole host of other issues. There is abnormal signaling in the gut and in the brain. Beta cells are not secreting normally. Glucagon levels are too high. We know about the ominous octet. Many issues are involved in the pathogenesis of type 2 diabetes. We know that giving insulin works, but we are not treating all of those issues. Giving a GLP-1 receptor agonist can be very helpful, but for patients with significant insulin deficiency, that might not be enough.

In the clinical trials^[1,2,3,4,5]where they combined the GLP-1 receptor agonist with a long-acting insulin and dosed it up slowly like they were dosing up basal insulin, they got very good reductions in