Hormonal
Fixed-ratio combinations (FRCs) of basal insulin and GLP-1 receptor agonists (GLP-1RA) provide superior glycemic control and weight loss compared to either component alone, but are limited by a low GLP-1RA dose relative to the insulin dose, making separate dosing preferable for obese patients requiring higher GLP-1RA doses.
Fixed-ratio combinations (like IDegLira, iGlarLixi, or IcoSema) are effective for lowering blood sugar and weight compared to using just insulin or just a GLP-1 drug. However, because the ratio of insulin to GLP-1 drug is fixed, these combinations often deliver too little GLP-1 drug for obese patients who need higher doses for maximum weight loss and glucose control. If you are obese or need high doses of GLP-1RA, separate injections of basal insulin and GLP-1RA allow you to titrate each drug independently to your optimal dose.
However, all FRCs are limited by the low GLP-1RA dose relative to the insulin delivered. Whenever higher GLP-1RA doses are required (i.e., in obese people), the option of separate dosing of BI and GLP-1RA with independent titration of each component should be considered.
Why this rating
Based on an overview of multiple randomized clinical trials (DUAL, LixiLan, COMBINE programs) comparing FRCs to monotherapies and basal-bolus insulin.
Source
An overview of randomized clinical trials of fixed‐ratio combinations of basal insulin plus <scp>GLP</scp> ‐ <scp>1RA</scp> (injectable therapy): Lessons for advancing therapy in people with type 2 diabetes
Geremia B. Bolli et al. · Diabetes Obesity and Metabolism · 2025
DOI 10.1111/dom.16616
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