Background/Objectives: Egypt ranks among the top ten countries globally with the highest burden of type 2 diabetes mellitus (T2DM), with prevalence projected to rise significantly by 2050. Despite multiple therapeutic options, glycemic control remains suboptimal due to therapeutic inertia, treatment complexity, and healthcare system limitations. Fixed-ratio combinations (FRCs) of basal insulin and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) offer a simplified injectable strategy addressing complementary pathophysiological defects in T2DM. This study aims to develop expert consensus recommendations for the use of FRCs in Egyptian adults with T2DM, integrating international evidence with local practice. Methods: A modified Delphi technique was employed to achieve consensus among 9 diabetes experts across Egypt. Statements were formulated based on a targeted literature review and voted on using a structured Likert scale. Consensus was defined as ≥70% agreement. Results: Twenty-nine statements were endorsed with strong to very strong consensus. Recommendations covered patient selection, initiation after oral therapy or GLP-1 RA, switching from premixed or complex insulin regimens, dosing strategies, safety considerations, and intensification options. FRCs were favored for early injectable use, regimen simplification, and improved adherence, with liraglutide-based FRCs preferred for cardiovascular and renal benefits. Digital health integration was strongly recommended to enhance glycemic control and patient engagement. Conclusions: FRCs offer a simple and effective treatment simplification option for patients with uncontrolled T2DM on premix insulin, complex insulin regimens, or oral therapy. FRCs may improve glycemic control with generally favorable effects on hypoglycemia risk and body weight across many randomized and real-world studies, while reducing injection burden, simplifying the treatment regimen, and supporting patient adherence and satisfaction.
Assaad-Khalil et al. (Wed,) studied this question.