Benefits of combination of insulin degludec and liraglutide are independent of baseline glycated haemoglobin level and duration of type 2 diabetes.
OBJECTIVE
To evaluate, using post hoc analyses, whether the novel combination of a basal insulin, insulin degludec, and a glucagon-like peptide-1 receptor agonist, liraglutide (IDegLira), was consistently effective in patients with type 2 diabetes (T2D), regardless of the stage of T2D progression.


METHODS
Using data from the DUAL I extension [insulin-naïve patients uncontrolled on oral antidiabetic drugs (OADs), n = 1660, 52 weeks] and DUAL II (patients uncontrolled on basal insulin plus OADs, n = 398, 26 weeks) randomized trials, the efficacy of IDegLira was investigated with regard to measures of disease progression stage including baseline glycated haemoglobin (HbA1c), disease duration and previous insulin dose.


RESULTS
Across four categories of baseline HbA1c (≤7.5-9.0%), HbA1c reductions were significantly greater with IDegLira (1.1-2.5%) compared with IDeg or liraglutide alone in DUAL I. In DUAL II, HbA1c reductions were significantly greater with IDegLira (0.9-2.5%) than with IDeg in all but the lowest HbA1c category. In DUAL I, insulin dose and hypoglycaemia rate were lower across all baseline HbA1c categories for IDegLira versus IDeg, while hypoglycaemia was higher with IDegLira than liraglutide, irrespective of baseline HbA1c. In DUAL II, insulin dose and hypoglycaemia rate were similar with IDegLira and IDeg (maximum dose limited to 50 U) independent of baseline HbA1c. The reduction in HbA1c with IDegLira was independent of disease duration and previous insulin dose but varied depending on pre-trial OAD treatment.


CONCLUSIONS
IDegLira effectively lowered HbA1c across a range of measures, implying suitability for patients with either early or advanced T2D.
Endocrine and Metabolic Consultants, Rockville, MD, USA.
H W
HW
Rodbard
Diabetes Care Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
J B
JB
Buse
Department of Endocrinology, University of Manitoba, Winnipeg, MB, Canada.
V
V
Woo
Diabetes Research Division, Gentofte Hospital, University of Copenhagen, Hellerup, Copenhagen, Denmark.
T
T
Vilsbøll
Novo Nordisk A/S, Søborg, Denmark.
I H
IH
Langbakke
Novo Nordisk A/S, Søborg, Denmark.
K
K
Kvist
Oxford Centre for Diabetes Endocrinology and Metabolism, Academic Health Science Network, NIHR Oxford Biomedical Research Centre, Oxford, UK.
S C L
SC
Gough
D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis* / Q000187:drug effects; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D049528:Insulin, Long-Acting / Q000008:administration & dosage*; D000069450:Liraglutide / Q000008:administration & dosage*; D008297:Male; D008687:Metformin / Q000008:administration & dosage; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D000069450:Liraglutide; D008687:Metformin; C517652:hemoglobin A1c protein, human; C571886:insulin degludec
GLP-1 analogue; basal insulin; glycaemic control; type 2 diabetes