Lyxumia (lixisenatide) is a once-daily injectable medication used to manage type 2 diabetes in adults. As a glucagon-like peptide-1 (GLP-1) receptor agonist, Lyxumia works by enhancing insulin secretion when blood glucose rises, suppressing glucagon release, and slowing gastric emptying. It is prescribed alongside other diabetes treatments—such as metformin, sulfonylureas, or basal insulin—when diet, exercise, and existing medications do not achieve adequate blood glucose control. Lyxumia is particularly effective at reducing post-meal glucose spikes and may support modest weight loss, making it a valuable option for many people with type 2 diabetes.

What Is Lyxumia and How Does It Work?

Lyxumia (lixisenatide) is a once-daily injectable medication used in the management of type 2 diabetes mellitus. It belongs to a class of drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists, which work by mimicking the action of naturally occurring incretin hormones in the body. Lyxumia is manufactured by Sanofi and is licensed by the Medicines and Healthcare products Regulatory Agency (MHRA) for use in combination with oral glucose-lowering medicines and/or basal insulin in adults with type 2 diabetes when these, together with diet and exercise, do not provide adequate glycaemic control.

Lixisenatide is a short-acting GLP-1 receptor agonist with a pronounced effect on postprandial (after-meal) glucose levels. Its mechanism of action centres on its ability to enhance glucose-dependent insulin secretion from pancreatic beta cells. When blood glucose levels rise after eating, Lyxumia stimulates the pancreas to release insulin in proportion to the glucose concentration. Importantly, this glucose-dependent action means that insulin secretion diminishes as blood glucose levels normalise, which reduces the risk of hypoglycaemia compared to some other diabetes medications.

Additionally, Lyxumia suppresses glucagon secretion from pancreatic alpha cells. Glucagon is a hormone that raises blood glucose by promoting glucose release from the liver; by reducing inappropriate glucagon secretion, Lyxumia helps prevent excessive glucose production. The medication also slows gastric emptying, which moderates the rate at which glucose enters the bloodstream after meals. This multi-faceted approach addresses several of the underlying metabolic abnormalities in type 2 diabetes, making Lyxumia an effective adjunctive therapy when used alongside other glucose-lowering treatments.

Important: Lyxumia should not be used in combination with a DPP-4 inhibitor (such as sitagliptin or linagliptin), as both drug classes work on the incretin system and combining them is not recommended.

References: MHRA/emc Summary of Product Characteristics (SmPC) for Lyxumia; EMA European Public Assessment Report (EPAR) for Lyxumia; NICE guideline NG28: Type 2 diabetes in adults: management.

Who Can Benefit from Lyxumia Treatment?

Lyxumia is indicated for adults with type 2 diabetes whose blood glucose levels remain inadequately controlled despite lifestyle modifications and existing medication. According to NICE guidance (NG28) on type 2 diabetes management, a GLP-1 receptor agonist such as Lyxumia may be considered:

• As part of triple therapy (in combination with metformin and another oral agent, such as a sulfonylurea or SGLT2 inhibitor) if the person has a body mass index (BMI) of 35 kg/m² or above (adjust the BMI threshold by 2.5 kg/m² for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family backgrounds) and specific psychological or medical problems associated with obesity, or if BMI is lower than 35 kg/m² and: – Therapy with insulin would have significant occupational implications, or – Weight loss would benefit other significant obesity-related comorbidities

• In combination with basal insulin (with or without metformin) when further intensification of diabetes therapy is required

Lyxumia is particularly suitable for individuals who would benefit from weight-neutral or modest weight-reducing therapy, as GLP-1 receptor agonists typically do not cause weight gain and may facilitate modest weight loss.

However, Lyxumia is not appropriate for everyone. It is not indicated for type 1 diabetes or for the treatment of diabetic ketoacidosis. Use is not recommended in patients with severe renal impairment (eGFR <30 mL/min/1.73 m²); closer monitoring is advised if eGFR is between 30 and 50 mL/min/1.73 m². Caution is also advised in individuals with severe gastrointestinal disease or a history of pancreatitis. Lyxumia is not recommended during pregnancy or breastfeeding; if you are planning a pregnancy or become pregnant, discuss discontinuing Lyxumia with your diabetes team and switching to an alternative treatment. Women of childbearing potential should discuss contraception needs individually with their healthcare provider. Lyxumia should not be used in combination with a DPP-4 inhibitor (such as sitagliptin, saxagliptin, or linagliptin).

Your GP or diabetes specialist will assess your individual circumstances, including your HbA1c levels, renal function, BMI, and treatment goals, to determine whether Lyxumia is an appropriate option for you.

References: NICE guideline NG28: Type 2 diabetes in adults: management; MHRA/emc SmPC for Lyxumia.

What to Expect When Taking Lyxumia

Lyxumia is administered as a subcutaneous injection once daily, ideally within one hour before the same meal each day (either the first meal of the day or the evening meal, whichever is most convenient and consistent). Do not inject Lyxumia after a meal. The medication comes in a pre-filled pen device designed for ease of use, and patients receive training from their diabetes nurse or healthcare professional on proper injection technique. Injection sites typically include the abdomen, thigh, or upper arm, and it is important to rotate injection sites to reduce the risk of lipodystrophy (changes in fat tissue under the skin).

Treatment usually begins with a starting dose of 10 micrograms daily for the first 14 days. This initial lower dose helps minimise gastrointestinal side effects as your body adjusts to the medication. After two weeks, the dose is increased to the maintenance dose of 20 micrograms daily. If you miss a dose, you should take it within one hour before your next meal; if this is not possible, skip the missed dose and resume your normal schedule. Do not take an extra dose to make up for a missed dose.

Common side effects of Lyxumia include:

• Nausea and vomiting (particularly during the first few weeks)

• Diarrhoea

• Headache

• Dizziness

• Injection site reactions (redness, itching)

These gastrointestinal symptoms typically improve over time as your body adapts to treatment. Staying well-hydrated can help manage these effects. If you experience persistent vomiting or diarrhoea, seek medical review promptly, as dehydration can lead to acute kidney injury, especially if you have existing kidney disease. Hypoglycaemia (low blood sugar) is uncommon with Lyxumia alone but may occur when used in combination with sulfonylureas or insulin; your doctor may need to reduce the doses of these medications when starting Lyxumia to lower the risk of hypoglycaemia.

Important interaction advice: Because Lyxumia slows gastric emptying, it can affect the absorption of other oral medicines. If you take oral contraceptives, antibiotics, paracetamol, or warfarin, you may need to take them at least 1 hour before or at least 4 hours after your Lyxumia injection. If you are on warfarin, your INR (blood clotting) should be monitored more frequently when starting or stopping Lyxumia. Discuss the timing of all your medicines with your healthcare team.

You should call 999 or 112 immediately if you experience signs of a severe allergic reaction (anaphylaxis), such as difficulty breathing, swelling of the face or throat, or severe hypoglycaemia with confusion or seizure. Seek urgent same-day medical assessment if you develop severe, persistent abdominal pain that may radiate to the back, as this could indicate pancreatitis. Contact your GP or call NHS 111 for advice if you have recurrent hypoglycaemia or other concerning symptoms.

Reporting side effects: If you experience any side effects, talk to your doctor, pharmacist, or diabetes nurse. You can also report suspected side effects directly via the MHRA Yellow Card scheme at www.mhra.gov.uk/yellowcard or search for 'MHRA Yellow Card' in the Google Play or Apple App Store.

Regular monitoring of your HbA1c, renal function, and overall diabetes control will be arranged by your healthcare team.

References: MHRA/emc SmPC for Lyxumia; NHS patient information on GLP-1 receptor agonists and diabetes medicines; MHRA Yellow Card scheme.

What Does Lyxumia Do for Type 2 Diabetes?

The primary therapeutic effect of Lyxumia is to improve glycaemic control by lowering both fasting and, particularly, post-meal (postprandial) blood glucose levels. Clinical trials (including the GetGoal programme) have demonstrated that Lyxumia can reduce HbA1c (a measure of average blood glucose over the preceding 2–3 months) by approximately 0.5–0.9% when added to existing diabetes therapy. This reduction is clinically meaningful and contributes to lowering the long-term risk of diabetes-related complications, including microvascular damage to the eyes (retinopathy), kidneys (nephropathy), and nerves (neuropathy).

As a short-acting GLP-1 receptor agonist, Lyxumia is particularly effective at controlling post-meal glucose spikes. By slowing gastric emptying and enhancing glucose-dependent insulin secretion, it addresses the sharp rises in blood glucose that occur after eating—a common challenge in type 2 diabetes management. This postprandial glucose control is important because elevated post-meal glucose levels contribute to overall glycaemic burden and cardiovascular risk.

Unlike some diabetes medications, Lyxumia typically has a neutral or beneficial effect on body weight. Many patients experience modest weight loss (averaging 1–3 kg in clinical studies), which can be advantageous given that weight management is a key component of type 2 diabetes care. This contrasts with certain other glucose-lowering therapies, such as sulfonylureas and insulin, which may promote weight gain.

Regarding cardiovascular outcomes, the ELIXA cardiovascular outcomes trial demonstrated that Lyxumia has neutral cardiovascular effects—it does not increase cardiovascular risk, though it has not been shown to reduce major adverse cardiovascular events in the same way as some other GLP-1 receptor agonists (such as liraglutide or semaglutide).

The medication's benefits must be weighed against potential adverse effects, and treatment should be reviewed regularly. NICE recommends that GLP-1 receptor agonist therapy (when used as part of triple therapy) should only be continued if there is a beneficial metabolic response at six months, typically defined as:

• A reduction in HbA1c of at least 1% (11 mmol/mol), and

• Weight loss of at least 3% of initial body weight

When Lyxumia is used in combination with basal insulin, clinical judgement and individualised treatment goals should guide continuation decisions. Your diabetes team will monitor your progress and adjust your treatment plan accordingly to ensure optimal diabetes management.

References: MHRA/emc SmPC for Lyxumia; NICE guideline NG28: Type 2 diabetes in adults: management; ELIXA cardiovascular outcomes trial (Pfeffer MA et al., N Engl J Med 2015); EMA EPAR for Lyxumia.

Frequently Asked Questions