Diabetes research and clinical practice · 2026
Guideline on treatment intensification with injectable therapies beyond GLP-1 RA based therapies in type 2 diabetes.
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Luo Yingying, Xia Jun, Yao Xiaomei, Jahed Seyed Adel, Bee Yong Mong, Chen Liming, Chan Siew Pheng, Deerochanawong Chaicharn, Shan Kong Alice Pik, Nguyen Khue Thy, Li Xiaoying, Lim Soo, Loganadan Navin Kumar, McGill Margaret, Trejo Selva Elizabeth, Yabe Daisuke, Yan Li, Li Peipei, Zhao Zhan, Chen Shihui, Cheng Alice Y Y, Ji Linong, Chinese Association of Geriatric Research
Аннотация
UNLABELLED: Guideline on Treatment Intensification with Injectable Therapies Beyond GLP-1 RA Monotherapy in Type 2 Diabetes.
AIMS: To provide evidence-based recommendations for selecting injectable therapies in adults with type 2 diabetes (T2DM) who have suboptimal response to GLP‑1 receptor agonists (GLP‑1 RAs).
METHODS: Using the GRADE framework, a systematic search (updated November 2025) identified eight RCTs evaluating four intensification strategies (switching to another GLP‑1 RA, switching to dual GIP/GLP‑1 RA, switching to fixed‑ratio combination (FRC), or adding basal insulin). A 22‑member Guideline Development Group from 11 Asia‑Pacific countries formulated recommendations requiring ≥ 80% consensus. AGREE and RIGHT checklists guided reporting.
RESULTS: The panel conditionally recommends against switching to another GLP‑1 RA (very low certainty). It conditionally recommends switching to dual GIP/GLP‑1 RA (low certainty) for glycemic and weight benefits, switching to FRC (very low to moderate certainty) when prioritizing glycemic improvement, and adding basal insulin (low certainty) with structured education. Choice among strategies should be individualized.
CONCLUSIONS: This guideline offers a framework for treatment intensification beyond GLP‑1 RA monotherapy in T2DM, emphasizing shared decision‑making based on glycemic goals, hypoglycemia risk, weight needs, and patient preferences.
AIMS: To provide evidence-based recommendations for selecting injectable therapies in adults with type 2 diabetes (T2DM) who have suboptimal response to GLP‑1 receptor agonists (GLP‑1 RAs).
METHODS: Using the GRADE framework, a systematic search (updated November 2025) identified eight RCTs evaluating four intensification strategies (switching to another GLP‑1 RA, switching to dual GIP/GLP‑1 RA, switching to fixed‑ratio combination (FRC), or adding basal insulin). A 22‑member Guideline Development Group from 11 Asia‑Pacific countries formulated recommendations requiring ≥ 80% consensus. AGREE and RIGHT checklists guided reporting.
RESULTS: The panel conditionally recommends against switching to another GLP‑1 RA (very low certainty). It conditionally recommends switching to dual GIP/GLP‑1 RA (low certainty) for glycemic and weight benefits, switching to FRC (very low to moderate certainty) when prioritizing glycemic improvement, and adding basal insulin (low certainty) with structured education. Choice among strategies should be individualized.
CONCLUSIONS: This guideline offers a framework for treatment intensification beyond GLP‑1 RA monotherapy in T2DM, emphasizing shared decision‑making based on glycemic goals, hypoglycemia risk, weight needs, and patient preferences.