Short Duration of Diabetes Should Be Associated with More Prominent Effect of Liraglutide—Titrated from Insulin Degludec plus Liraglutide Combination Therapy

Abstract

Objective: In management of type 2 diabetes (T2DM), controlling HbA1c <7% is required. We examined effectiveness of insulin degludec (DEG) plus liraglutide (LIRA) combination therapy in Japanese T2DM patients. Methods: Hospitalized hyperglycemic 55 patients with T2DM who started this therapy were randomly recruited. Changes of HbA1c, Insulin doses, and ADRR in patients who did self-blood glucose monitoring (SMBG) were evaluated for a year after discharge. Since preserved β-cell function might influence the effect, effectiveness was compared by duration of T2DM ≤ 5 year (n=27) or ≥ 6 year (n=28). Results: 1) Baseline characteristics: Patients with short duration (SHORT) were younger (62±9.5 vs. 69.9±11.8 years old: p<0.05), had shorter duration (0.44±1.3 vs. 17.1±9.3 year:p<0.01), higher urinary C-peptide (91.1±4.6 vs. 47.0±30μg/day: p<0.01), higher HbA1c (12.4±2.5 vs. 11.0±2.3%: p<0.05), and lower final dose of liraglutide (0.68±0.18 vs. 0.78±0.17mg/day: p<0.05) compared with long duration (LONG) group. 2) Mean HbA1c in 55 patients have reached the target from 3rd month to 12th month. 3) Although daily glucose excursions at discharge and mean body weight were identical throughout a year in 2 groups, HbA1c in SHORT group dramatically improved after discharge. The average of HbA1c was maintained ≤ 6.0% from 4th month to 12th month. 4) Patients with HbA1c ≤ 6.0% using SMBG showed lower ADRR scores (1∼9). 5) The combined use of DEG and its dose gradually decreased in SHORT group, one third of patients could quit DEG at 6th month and over half at 12th month, but none in LONG group. 6) Although Long group had higher rates of chronic kidney disease (CKD) 46.4% and ischemic heart disease (IHD) 28.5%, SHORT group still had high rates of CKD 22.2% and IHD 18.5%. Conclusion: Since T2DM is a complex metabolic disorder, prominent effect of LIRA in the patients with short duration is supportive for GLP-1 receptor agonists as a first-line therapy. Disclosure K. Kashima: None. H. Shimizu: Speaker's Bureau; Self; Eli Lilly and Company, MSD K.K., Daiichi Sankyo Company, Limited, Nippon Boehringer Ingelheim Co. Ltd., Novo Nordisk Inc.. M. Yamada: None.