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Haluzik M, Taybani Z, Araszkiewicz A, Cerghizan A, Mankovsky B, Zuhdi A, Malecki M. Expert Opinion on Optimising Type 2 Diabetes Treatment Using Fixed-Ratio Combination of Basal Insulin and GLP-1 RA for Treatment Intensification and Simplification. Diabetes Ther 2024:10.1007/s13300-024-01610-w. [PMID: 38935189 DOI: 10.1007/s13300-024-01610-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
The management of type 2 diabetes (T2D) often necessitates treatment intensification, and sometimes simplification to achieve glycaemic targets and mitigate complications. This expert opinion paper evaluates the use and positioning of the fixed-ratio combinations (FRCs) of basal insulin (BI) and glucagon-like peptide 1 receptor agonists (GLP-1 RAs) in optimising T2D management. On the basis of the evidence presented and discussions, these FRCs offer a promising approach for both treatment intensification and simplification in people with suboptimal glucose control despite receiving various therapies. In treatment intensification, FRCs provide a synergistic effect by addressing multiple pathophysiological defects contributing to hyperglycaemia. These FRCs effectively control both fasting and postprandial glucose (PPG) excursions, offering significantly improved glycaemic control with a lower hypoglycaemia risk and weight neutrality compared to traditional or complex insulin regimens. Moreover, the reduced injection frequency (once daily) and flexibility in the dosing schedule (with any major meal of the day) help mitigate patient resistance to insulin initiation or titration. This further reduces treatment burden, facilitating treatment adherence and enhancing patient convenience. These key benefits of FRCs over complex insulin regimens play a crucial role in long-term glycaemic management and overall treatment outcomes. Hence, the timely use of FRCs in the treatment algorithm for people with T2D represents a valuable strategy for optimising glycaemic control, addressing treatment barriers and enhancing patient-reported outcomes.
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Affiliation(s)
- Martin Haluzik
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21, Prague 4, Czech Republic.
| | - Zoltan Taybani
- 1st Department of Endocrinology, Békés County Central Hospital, Dr Réthy Pál Member Hospital, Békécsaba, Hungary
| | - Aleksandra Araszkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznań, Poland
| | - Anca Cerghizan
- Diabetes Center, Emergency Country Hospital, Cluj-Napoca-Napoca, Romania
| | - Boris Mankovsky
- Department of Diabetology, National Healthcare University of Ukraine, Kiev, Ukraine
| | - Agbaria Zuhdi
- Clalit Health Services, Degani, Hadera, Israel
- Taybeh Specialist Doctor's Clinic, Taybeh, Israel
| | - Maciej Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
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Di Loreto C, Celleno R, Pezzuto D, Ambrosi F, Bellavita S, Biagini M, Passeri M, Del Sindaco P. Effectiveness, Simplification and Persistence of IDegLira in Poorly Controlled People with Type 2 Diabetes: A 4-Year Follow-Up Real-World Study. Diabetes Ther 2024; 15:1313-1331. [PMID: 38605275 PMCID: PMC11096145 DOI: 10.1007/s13300-024-01564-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
INTRODUCTION Efficacy and safety of the fixed ratio combination of insulin degludec and liraglutide (IDegLira) has been largely documented. However, long-term data are limited. This study aimed at describing persistence in therapy and the effectiveness at 48 months of IDegLira. METHODS We conducted an observational study based on retrospective chart review. All patients treated with IDegLira during 2018-2022 were included. Data on treatment approaches and clinical outcomes were collected at the first prescription of IDegLira (T0) and after 6, 12, 24, 36, and 48 months. RESULTS Overall, 156 patients (mean age 68 years, 64.1% men) started IDegLira, of whom 88 (56.4%) were previously treated with basal-oral therapy (BOT) and 68 (43.6%) with basal-bolus schemes (BB). Before starting IDegLira, 23.8% were treated with ≥ 2 oral antihyperglycemic agents in association with insulin; at T0, the proportion decreased to 3.2%. Short-acting insulin was discontinued after the first week. After 48 months, levels of HbA1c were significantly reduced by 1.34% in the BOT group and 1.07% in the BB group (p < 0.0001 in both groups). In the BOT group, FBG levels decreased by about 50 mg/dl and body weight was unchanged. In the BB group, FBG levels decreased by about 40 mg/dl and body weight was significantly reduced by an average of 7.7 kg. Five patients (3.2%) interrupted therapy with IDegLira during 48 months, and no severe hypoglycemia occurred. CONCLUSIONS Our study emphasizes the important role of IDegLira in maintaining a good metabolic control while minimizing the risk of major hypoglycemia and weight gain in the long term. The substantial simplification of treatment schemes can increase adherence.
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Affiliation(s)
- Chiara Di Loreto
- U.O.S. Diabetologia, Distretto del Perugino, USL Umbria 1, "Poliambulatorio Europa", Perugia, Italy.
| | - Roberta Celleno
- U.O.S. Diabetologia, Distretto del Perugino, USL Umbria 1, "Poliambulatorio Europa", Perugia, Italy
| | - Debora Pezzuto
- U.O.S. Diabetologia, Distretto del Perugino, USL Umbria 1, "Poliambulatorio Europa", Perugia, Italy
| | - Franca Ambrosi
- U.O.S. Diabetologia, Distretto del Perugino, USL Umbria 1, "Poliambulatorio Europa", Perugia, Italy
| | - Silvia Bellavita
- U.O.S. Diabetologia, Distretto del Perugino, USL Umbria 1, "Poliambulatorio Europa", Perugia, Italy
| | - Marinella Biagini
- U.O.S. Diabetologia, Distretto del Perugino, USL Umbria 1, "Poliambulatorio Europa", Perugia, Italy
| | - Monica Passeri
- U.O.S. Diabetologia, Distretto del Perugino, USL Umbria 1, "Poliambulatorio Europa", Perugia, Italy
| | - Paola Del Sindaco
- U.O.S. Diabetologia, Distretto del Perugino, USL Umbria 1, "Poliambulatorio Europa", Perugia, Italy
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Novodvorský P, Thieme L, Laňková I, Mráz M, Taybani ZJ, Bótyik B, Stella P, Vytasil M, Lauand F, Bonnemaire M, Haluzík M. The IDEAL (Insulin therapy DE-intensificAtion with iglarLixi) Randomised Controlled Trial-Study Design and Protocol. Diabetes Ther 2024; 15:1461-1471. [PMID: 38653903 PMCID: PMC11096133 DOI: 10.1007/s13300-024-01582-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Multiple daily injection insulin regimen (MDI) represents the most intensive insulin regimen used in the management of people with type 2 diabetes (PwT2D). Its efficacy regarding glycaemic control is counterbalanced by the increased risk of hypoglycaemia, frequently observed tendency to weight gain and necessity for frequent glucose monitoring. Recent introduction of novel antidiabetic medications with pleiotropic effects reaching far beyond the reduction of glycaemia (HbA1c), such as the glucagon-like peptide 1 receptor agonist (GLP-1 RA), has significantly widened the therapeutic options available for management of T2D. Consequently, there is currently a substantial number of PwT2D for whom the MDI regimen was initiated at a time when no other options were available. Yet, in present times, these individuals could benefit from simplified insulin regimens ideally taking advantage of the beneficial effects of the novel classes of antidiabetic medications. iGlarLixi (Suliqua®) is a once-daily fixed-ratio combination of basal insulin analogue glargine 100 U/ml and a GLP-1 RA lixisenatide. METHODS Insulin therapy DE-intensificAtion with iglarLixi (IDEAL) is a six-centre, open-label, parallel-group, active comparator, phase IV randomised controlled trial with a 24-week active treatment period examining the efficacy and safety of MDI regimen de-intensification with once-daily administration of iGlarLixi versus MDI regimen continuation in PwT2D on a backgroud therapy with metformin ± sodium-glucose cotransporter 2 inhibitor. PLANNED OUTCOMES The primary objective is to compare the effects of MDI therapy de-intensification with iGlarLixi versus MDI regimen continuation regarding glycaemic control (HbA1c). Secondary objectives include detailed evaluation of the effects of MDI regimen de-intensification with iGlarLixi on glycaemic control using standardised continuous glucose monitoring (CGM) metrics and self-monitoring of plasma glucose. Furthermore, body weight and body composition analysis, quality of life and safety profile are evaluated. TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT04945070.
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Affiliation(s)
- Peter Novodvorský
- Diabetes Centre, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague 4, Czech Republic
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Lenka Thieme
- Diabetes Centre, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague 4, Czech Republic
| | - Ivana Laňková
- Diabetes Centre, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague 4, Czech Republic
| | - Miloš Mráz
- Diabetes Centre, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague 4, Czech Republic
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zoltán J Taybani
- First Department of Endocrinology, Dr. Réthy Pál Member Hospital, Békes County Central Hospital, Békéscsaba, Hungary
| | - Balázs Bótyik
- First Department of Endocrinology, Dr. Réthy Pál Member Hospital, Békes County Central Hospital, Békéscsaba, Hungary
| | | | | | | | | | - Martin Haluzík
- Diabetes Centre, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague 4, Czech Republic.
- First Faculty of Medicine, Charles University, Prague, Czech Republic.
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Fadini GP, Buzzetti R, Pitocco D, Tortato E, Scatena A, Lamacchia O, Lastoria G, Simoni L, Consoli A. IDegLira for the real-world treatment of type 2 diabetes in Italy. Final results from the REX observational study. Diabetes Obes Metab 2024; 26:1746-1756. [PMID: 38327240 DOI: 10.1111/dom.15486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/09/2024]
Abstract
AIM The study was designed to generate real-world evidence on IDegLira in the Italian clinical practice in two groups of patients with type 2 diabetes (T2D), switching to IDegLira either from a basal only (basal group) or basal-bolus insulin regimen (BB group). MATERIALS AND METHODS This was a non-interventional, multicentre, single-cohort, prospective study assessing the long-term glycaemic control in patients with T2D, who switched to IDegLira from a basal insulin ± glucose-lowering medication regimen with or without a bolus insulin component for approximately 18 months, conducted in 28 Italian diabetes centres. The primary endpoint was the change in glycated haemoglobin (HbA1c) levels from baseline to 6 months after IDegLira initiation. RESULTS The study included 358 patients with a mean age 67.2 years and diabetes duration of 15.7 years. HbA1c significantly decreased from IDegLira start to all study time points in the overall population (basal group -1.19%; BB group -0.60% at the end of observation). Patients achieving HbA1c <7% levels increased from 12.9% (n = 43) to 40.3% (n = 110) at 18 months. Fasting blood glucose and body weight also significantly decreased in both groups, although more in the BB group. Overall, 14.3% of completed patients had an intensification of treatment (mainly in the basal group) and 48.6% had a simplification of treatment (mainly in the BB group). CONCLUSIONS Switching to IDegLira in a real-world clinical setting is a valid therapeutic option for patients with T2D with inadequate glycaemic control on basal or BB insulin regimen and/or need to simplify their insulin therapy, with specific reasons and therapeutic goals according to different T2D management trajectories.
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Affiliation(s)
- Gian Paolo Fadini
- Department of Medicine, University of Padova, Padua, Italy
- Division of Metabolic Diseases, Padova Hospital, Padua, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Dario Pitocco
- Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elena Tortato
- Metabolic Diseases and Diabetology Department, IRCCS INRCA, Ancona, Italy
| | | | - Olga Lamacchia
- Endocrinology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giusi Lastoria
- Clinical Medical & Regulatory Department, Novo Nordisk SpA, Rome, Italy
| | - Lucia Simoni
- Medineos Observational Research, an IQVIA Company, Modena, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences (DMSI) and Center for Advanced Studies and Technology (CAST), University G. D'Annunzio, Chieti, Italy
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