Switching from Insulin Degludec plus Dipeptidyl Peptidase-4 Inhibitor to Insulin Degludec/Liraglutide Improves Glycemic Variability in Patients with Type 2 Diabetes: A Preliminary Prospective Observation Study.

Yuki Oe,Hiraku Kameda,Ayano Yasui,Kyu Yong Cho,Tatsuya Atsumi,Akinobu Nakamura,Yuka Takahashi,Aika Miya,Rimi Izumihara,Hideaki Miyoshi,Hiroshi Nomoto,Saki Kuwabara

doi:10.1155/2022/5603864

Abstract

Incretins reduce glycemic variability (GV) in patients with type 2 diabetes, but it is unknown whether switching from a combination of basal insulin and a DPP-4 inhibitor to insulin degludec/liraglutide (IDegLira) improves GV. We performed an exploratory prospective observational study to compare the effect of IDegLira and the combination on GV. We recruited hospitalized patients with type 2 diabetes who had stable glycemic control with insulin degludec (≤16 units/day) and taking a DPP-4 inhibitor. GV was analyzed using continuous glucose monitoring (CGM) before and after switching the medication to IDegLira. The principal endpoint was the change in mean amplitude of glycemic excursions (MAGE). Other indices of GV and CGM parameters were analyzed as the secondary endpoints. Fifteen participants were enrolled and 12 completed the study. In these participants, the DPP-4 inhibitor and insulin degludec were discontinued, and the equivalent dose of IDegLira was commenced. Switching to IDegLira significantly improved MAGE from 74.9 (60.3, 97.7) mg/dL to 64.8 (52.0, 78.2) mg/dL (P < 0.05), as well as other indices of GV and 24-hour mean blood glucose concentration. Analysis of the ambulatory glucose profile showed marked reductions in postprandial glucose concentration. Nocturnal glucose concentration was similar under the two treatment regimens. IDegLira improved GV as well as the mean and the postprandial glucose concentration by switching from insulin degludec plus DPP-4 inhibitor combination. IDegLira might be beneficial for patients being treated with low-dose basal insulin.

Highlights

One of the important goals of the treatment of diabetes mellitus is to reduce the incidences of diabetic complications and mortality by improving glycemic control
In contrast to previous clinical trials, we evaluated the efficacy of IDegLira at relatively low doses and the participants were restricted to the patients on a combination therapy that included a dipeptidyl peptidase-4 (DPP-4) inhibitor
A dose of insulin degludec for inclusion criteria was within 16 units/day considering a maximum dose of IDegLira switching from basal insulin therapy was restricted to 16 dose/day

Summary

Introduction

One of the important goals of the treatment of diabetes mellitus is to reduce the incidences of diabetic complications and mortality by improving glycemic control. Glycated hemoglobin (HbA1c) is frequently used to evaluate glycemic control in clinical practice, it is thought that stable glycemic control, with minimal GV, is required for the prevention of diabetic cardiovascular complications in patients with type 2 diabetes (T2DM) [2]. Insulin treatment reduces fasting plasma glucose (FPG) and HbA1c effectively, it increases the risks of hypoglycemia and weight gain [6]. GLP-1RAs reduce postprandial glucose, but can have adverse gastrointestinal effects [7]. IDegLira is expected to reduce these risks by decreasing required amount of insulin and GLP-1RA for adequate glycemic control [8]

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Conclusion