Use of IDegLira to Intensify, Simplify, and Increase Appropriateness of Type2 Diabetes Therapy: A Real-Life Experience.

Abstract

Fixed ratio combination of insulin degludec and liraglutide (IDegLira) represents an option to revise inappropriate therapies in patients with poorly controlled type2 diabetes. This study aimed to assess the pattern of use and 1-year effectiveness of IDegLira. A retrospective chart review was performed to assess changes in glycated hemoglobin (HbA1c) (primary endpoint), fasting blood glucose (FBG), body weight, estimated glomerular filtration rate (eGFR), and lipid profile following IDegLira initiation. Previous versus concomitant diabetes treatments were also compared. Overall, 87 patients (mean age 73.9 ± 9.2years, diabetes duration 18.2 ± 6.7years, 62.1% men, HbA1c 8.3 ± 1.3%, BMI 30.4 ± 5.5kg/m2) initiated IDegLira. Previously, 21.8% of patients were treated with oral hypoglycemic agents (OHA group), 47.1% with basal insulin ± OHA (BOT group), 5.8% with GLP-1 RA ± basal insulin (GLP1-RA group), and 25.3% with basal-bolus schemes (BB group). At the first prescription of IDegLira, secretagogues and schemes including two or more OHA were substantially reduced, leaving metformin as the most prevalent OHA (81.6%) used in combination with IDegLira. Starting dose of IDegLira ranged from 18.7 ± 3.1U (OHA group) to 24.1 ± 4.4U (BB group). After 1year, HbA1c was significantly reduced by 1.25% (95%CI -1.48; -1.03), FBG by 52.9mg/dl, and body weight by 2.0kg. Also, eGFR levels and lipid profile significantly improved. No severe hypoglycemia occurred. It is possible to proactively review suboptimal or inappropriate diabetes treatment according to the most recent guidelines. Results suggest that initiation of IDegLira was associated with a reduction in drugs to be administered daily and relevant improvements in clinical outcomes.