title: One-year sustained glycemic control and weight reduction in type 2 diabetes after addition of liraglutide to metformin followed by insulin detemir according to HbA1c target.
abstract: OBJECTIVE
  To investigate durability of efficacy and safety over 1 year of the sequence of liraglutide added to metformin followed by add-on insulin detemir if glycated hemoglobin (HbA1c) remains ≥7.0%.
  
  
  METHODS
  Patients previously uncontrolled on metformin±sulfonylurea with HbA1c ≥7.0% after 12 weeks of adding liraglutide 1.8mg to metformin (run-in; sulfonylurea discontinued) were randomized 1:1 to 52 weeks' open-label add-on detemir (randomized treatment [RT] group; n=162) or continuation without detemir (randomized control [RC] group; n=161). Patients with HbA1c <7.0% continued 52 weeks' unchanged treatment (observational group; n=498).
  
  
  RESULTS
  Run-in HbA1c improvement from 8.3% to 7.6% (-0.6%) was further enhanced in the RT group (-0.50%) and maintained in the RC group (+0.01%) over 52 weeks; estimated treatment difference (ETD)[95%CI]: -0.51 [-0.70;-0.31]; P<0.0001. More RT (52%) than RC patients (22%) achieved HbA1c <7.0% at 52 weeks (P<0.0001). Run-in weight loss (-3.5kg) was maintained in the RT (-0.05kg) and enhanced in the RC group (-1.02kg) after 52 weeks; ETD [95%CI]: 0.97 [0.04;1.91]; P=0.04. No major hypoglycemia occurred; minor hypoglycemia rates were low across groups (0.034-0.228 events/patient-year).
  
  
  CONCLUSIONS
  Supplementing metformin+liraglutide with detemir for 52 weeks improved glycemic control with sustained weight loss and low hypoglycemia rate.
authors.affiliation: Dallas Diabetes and Endocrine Center at Medical City, Dallas, TX, USA.
authors.forename: Julio
authors.initials: J
authors.lastname: Rosenstock
authors.forename: Helena W
authors.initials: HW
authors.lastname: Rodbard
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Bain
authors.forename: David
authors.initials: D
authors.lastname: D'Alessio
authors.forename: Jochen
authors.initials: J
authors.lastname: Seufert
authors.forename: Anne B
authors.initials: AB
authors.lastname: Thomsen
authors.forename: Claus Bo
authors.initials: CB
authors.lastname: Svendsen
authors.forename: J Hans
authors.initials: JH
authors.lastname: DeVries
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D052216:Glucagon-Like Peptide 1 / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006442:Glycated Hemoglobin / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D000069057:Insulin Detemir; D049528:Insulin, Long-Acting / Q000008:administration & dosage*; D000069450:Liraglutide; D008297:Male; D008687:Metformin / Q000008:administration & dosage*; D008875:Middle Aged; D015431:Weight Loss / Q000187:drug effects*
chemical_list: D001786:Blood Glucose; D052216:Glucagon-Like Peptide 1; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069057:Insulin Detemir; D049528:Insulin, Long-Acting; D000069450:Liraglutide; D008687:Metformin; C517652:hemoglobin A1c protein, human
keywords: Insulin detemir; Liraglutide; Treatment intensification; Type 2 diabetes