IDegLira Achieved Non-Inferior A1C Reduction, Weight Loss and Fewer Hypoglycemic Episodes While Using a Simple Regimen with Fewer Injections and Dose Adjustments Compared with Basal–Bolus Therapy

Abstract

This post hoc analysis of DUAL VII evaluated treatment complexity of insulin degludec/liraglutide (IDegLira) vs. basal-bolus (BB) therapy in terms of the number of injections and dose adjustments. In the 26-week, open-label trial, patients with type 2 diabetes uncontrolled on metformin and 20-50U insulin glargine 100 U/mL (IG) were randomized 1:1 to IDegLira (n=252) or BB (IG+insulin aspart ≤4 times/day; n=254). IDegLira was initiated at 16U (16U insulin degludec + 0.58 mg liraglutide); initial IG dose was the pre-trial dose (mean 33U). Both were titrated twice weekly, based on the mean of 3 pre-breakfast self-monitored plasma glucose measurements (SMPG, target 4–5 mmol/L). Insulin aspart, initiated at 4U/main meal, was titrated twice weekly to a pre-prandial and bedtime SMPG (target 4–6 mmol/L). Despite the lower starting basal insulin dose with IDegLira vs. BB, the number of basal insulin dose adjustments was similar during treatment (16.6 and 17.1, respectively). The number of bolus adjustments during treatment increased steadily to a median of 218/patient (min=1; max=569). At Week 26, 66.5% of patients in the BB group were receiving ≥3 bolus injections/day in addition to IG and took SMPG measurements at each injection. Compared with BB, the clinical benefits of IDegLira (comparable A1C reduction, weight loss and significantly lower hypoglycemia rates ) were achieved with fewer daily injections, SMPG readings and dose adjustments in DUAL VII.