Real‐world study of the concomitant use of biphasic insulin aspart 30/70 with GLP‐1 receptor agonist versus first‐generation basal insulin with GLP‐1 receptor agonist in type 2 diabetes

Abstract Aims Combining insulin with a glucagon‐like peptide‐1 receptor agonist (GLP‐1RA) to treat type 2 diabetes (T2D) is common. While many studies have investigated concomitant therapy with basal insulin+GLP‐1RA, few have reported on premixed insulin+GLP‐1RA. We aimed to address this gap using data from the Clinical Practice Research Datalink Aurum database in England. Methods This retrospective cohort study with propensity score matching assessed glycaemic levels and other clinical outcomes in people with T2D, comparing biphasic insulin aspart 30/70 (BIAsp 30) + GLP‐1RA with basal insulin (insulin detemir/glargine U100) + GLP‐1RA (from 2006 to 2021). Results In total, 4770 eligible people were identified; 1511 had a BIAsp 30 + GLP‐1RA regimen and were propensity score‐matched to an equal number receiving basal+GLP‐1RA. There was no significant difference in glycated haemoglobin (HbA1c) reduction between cohorts at 6 months ( p = 0.15), with a decrease of −1.07 (95% CI: −1.16; −0.98) %‐points (−11.7 mmol/mol [95% CI: −12.7; –10.7]) in the BIAsp 30 + GLP‐1RA cohort, versus −0.97 (95% CI: −1.07; −0.88) %‐points (−10.6 mmol/mol [95% CI: −11.7; –9.6]) in the basal+GLP‐1RA cohort. Body mass index (BMI) decreased by −0.35 kg/m 2 (95% CI: −0.52;−0.18) at 6 months with BIAsp 30 + GLP‐1RA, versus −0.72 kg/m 2 (95% CI: −0.90;−0.54) with basal+GLP‐1RA ( p = 0.003). BMI was influenced by the initiation sequence of GLP‐1RA in relation to insulin ( p < 0.0001). Hypoglycaemia rates were low and not significantly different between cohorts. Conclusions Combining BIAsp 30 + GLP‐1RA provides glycaemic control with no significant difference to that of propensity score‐matched people receiving basal insulin+GLP‐1RA, with no increase in hypoglycaemia risk or weight gain.