title: IDegLira Improves Both Fasting and Postprandial Glucose Control as Demonstrated Using Continuous Glucose Monitoring and a Standardized Meal Test.
abstract: OBJECTIVE
  IDegLira is a novel, fixed-ratio combination of the long-acting basal insulin, insulin degludec, and the long-acting glucagon-like peptide-1 analog liraglutide. We studied the effect of IDegLira versus its components on postprandial glucose (PPG) in type 2 diabetes.
  
  
  METHODS
  In this substudy, 260 (15.6%) of the original 1663 patients with inadequate glycemic control participating in a 26-week, open-label trial (DUAL I) were randomized 2:1:1 to once-daily IDegLira, insulin degludec or liraglutide. Continuous glucose monitoring (CGM) for 72 hours and a meal test were performed.
  
  
  RESULTS
  At week 26, IDegLira produced a significantly greater decrease from baseline in mean PPG increment (normalized iAUC0-4h) than insulin degludec (estimated treatment difference [ETD] -12.79 mg/dl [95% CI: -21.08; -4.68], P = .0023) and a similar magnitude of decrease as liraglutide (ETD -1.62 mg/dl [95% CI: -10.09; 6.67], P = .70). CGM indicated a greater reduction in change from baseline in PPG increment (iAUC0-4h) for IDegLira versus insulin degludec over all 3 main meals (ETD -6.13 mg/dl [95% CI: -10.27, -1.98], P = .0047) and similar reductions versus liraglutide (ETD -1.80 mg/dl [95% CI: -2.52, 5.95], P = .4122). Insulin secretion ratio and static index were greater for IDegLira versus insulin degludec (P = .048 and P = .006, respectively) and similar to liraglutide (P = .45 and P = .895, respectively).
  
  
  CONCLUSIONS
  Once-daily IDegLira provides significantly better PPG control following a mixed meal test than insulin degludec. The improvement is at least partially explained by higher endogenous insulin secretion and improved beta cell function with IDegLira. The benefits of liraglutide on PPG control are maintained across all main meals in the combination.
authors.affiliation: NNF Center for Basic Metabolic Research and Department of Biomedical Sciences, Panum Institute, University of Copenhagen, Copenhagen, Denmark jjholst@sund.ku.dk holst@mfi.ku.dk.
authors.forename: Jens J
authors.initials: JJ
authors.lastname: Holst
authors.affiliation: University of North Carolina, Chapel Hill, NC, USA.
authors.forename: John B
authors.initials: JB
authors.lastname: Buse
authors.affiliation: Endocrine and Metabolic Consultants, Rockville, MD, USA.
authors.forename: Helena W
authors.initials: HW
authors.lastname: Rodbard
authors.affiliation: Coffs Harbour Diabetes Clinic, Coffs Harbour, Australia.
authors.forename: Sultan
authors.initials: S
authors.lastname: Linjawi
authors.affiliation: University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Woo
authors.affiliation: Novo Nordisk A/S, Søborg, Denmark.
authors.forename: Trine Welløv
authors.initials: TW
authors.lastname: Boesgaard
authors.affiliation: Novo Nordisk A/S, Søborg, Denmark.
authors.forename: Kajsa
authors.initials: K
authors.lastname: Kvist
authors.affiliation: Oxford Centre for Diabetes, Endocrinology and Metabolism, and NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Gough
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004338:Drug Combinations; D005215:Fasting; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D049528:Insulin, Long-Acting / Q000008:administration & dosage*; D000069450:Liraglutide / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D019518:Postprandial Period
chemical_list: D001786:Blood Glucose; D004338:Drug Combinations; D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; C571886:insulin degludec; D000069450:Liraglutide
keywords: combination therapy; diabetes therapy; incretins; insulin degludec; liraglutide; postprandial glucose; quality of glycemic control