Guideline on treatment intensification with injectable therapies beyond GLP-1 RA based therapies in type 2 diabetes.

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.