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Kis JT, Seufert J, Haluzík M, Bonnemaire M, Vera C, Tournay M, Freemantle N, Guja C. Real-Life Effectiveness of iGlarLixi (Insulin Glargine 100 U/ml and Lixisenatide) in People with Type 2 Diabetes (T2D) According to Baseline HbA1c and BMI. Diabetes Ther 2024:10.1007/s13300-024-01644-0. [PMID: 39276292 DOI: 10.1007/s13300-024-01644-0] [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: 06/21/2024] [Accepted: 08/19/2024] [Indexed: 09/16/2024] Open
Abstract
INTRODUCTION This study aimed to evaluate the effect of baseline body mass index (BMI) and glycated hemoglobin (HbA1c) on the effectiveness and safety of initiating iGlarLixi (insulin glargine 100 U/ml and lixisenatide) in people with type 2 diabetes (T2D) in routine clinical practice. METHODS We pooled patient-level data from 1406 people with inadequately controlled T2D, initiating a 24-week iGlarLixi treatment. Analysis sets were based on baseline BMI and HbA1c. In the BMI set, 894 (64%) people had a BMI ≥ 30 kg/m2 and 510 (36%) a BMI < 30 kg/m2; in the HbA1c set, 615 (44%) people had an HbA1c >9%, 491 (35%) between 8 and 9%, and 298 (21%) < 8%. RESULTS After initiating iGlarLixi, HbA1c decreased in all participants, with the greatest least-squares mean reduction at 2.15% from baseline to week 24 in those with baseline HbA1c > 9% (using a mixed model for repeated measures). Overall, mean ± standard deviation body weight decreased by 1.9 ± 4.8 kg, with the most prominent loss of 2.6 ± 4.9 kg recorded in people presenting with obesity. Reported hypoglycemia rates were low across all groups. CONCLUSIONS Initiation of iGlarLixi in people with uncontrolled T2D is effective and safe in clinical practice, across different baseline HbA1c and BMI categories.
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Affiliation(s)
- Janos T Kis
- Department of Internal Medicine Centrum, Szent János Hospital, Budapest, Hungary
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center, University of Freiburg, Freiburg, Germany
| | - Martin Haluzík
- Diabetes Centre, Institute for Clinical and Experimental Medicine and Charles University, Prague, Czech Republic
| | | | - Carine Vera
- Ividata Life Sciences, Levallois-Perret, France
| | - Mathilde Tournay
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Guo C, Lu Y. Early Conversion of Intensive Insulin Therapy to IDegLira Demonstrates Higher Efficacy and Safety in Reducing Fasting Blood Glucose and HbA1c in T2DM Patients. Diabetes Metab Syndr Obes 2024; 17:3217-3226. [PMID: 39224113 PMCID: PMC11368103 DOI: 10.2147/dmso.s472174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024] Open
Abstract
Background A short-term insulin intensive therapy is an important method used in clinical practice to control blood glucose, and a scientific post-treatment plan is key to long-term blood glucose stability control. This study aimed to investigate efficacy and safety of early conversion of intensive insulin therapy to IDegLira in T2DM patients. Methods This study was a prospective study, involving 80 T2DM patients finally. Patients were firstly treated with insulin for intensified therapy (Pre-IDegLira group), then switched to insulin degludec and liraglutide (IDegLira) for 3 months (IDegLira-3 months group). Data including HbA1c, fasting blood glucose, fasting C-peptide, weight, insulin dosage, total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were analyzed. Correlations between fasting blood glucose and other parameters were evaluated with Pearson correlation analysis. Results IDegLira early conversion significantly reduced fasting blood glucose (p<0.001), weight (p=0.015), and insulin dosage (p=0.001) of T2DM patients compared to those of Pre-IDegLira group. HbA1c level was remarkably lower in T2DM patients underwent IDegLira early conversion compared to that in Pre-IDegLira group (p<0.001), with HbA1c <7% proportion of 73.75% (59/80). IDegLira early conversion significantly downregulated levels of TC (p<0.001), TG (p<0.001), LDL-C (p<0.001), and upregulated HDL-C level (p=0.017) of T2DM patients, compared to those in Pre-IDegLira group. IDegLira early conversion markedly reduced ALT (p<0.001) and AST (p=0.002) levels of T2DM patients compared to those in Pre-IDegLira group. IDegLira early conversion demonstrated a positive correlation between fasting blood glucose and HbA1c (r=0.531, p<0.001) or TG level (r=0.336, p=0.002) in T2DM patients. Conclusion Early conversion of intensive insulin therapy to IDegLira effectively reduced fasting blood glucose and HbA1c in T2DM patients with higher safety.
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Affiliation(s)
- Caiyun Guo
- Department of Endocrinology, YuYao People’s Hospital, Ningbo, Zhejiang Province, People’s Republic of China
| | - Yang Lu
- Department of Endocrinology, YuYao People’s Hospital, Ningbo, Zhejiang Province, People’s Republic of China
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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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Romano I, Serra R. Use of IDegLira to Intensify, Simplify, and Increase Appropriateness of Type 2 Diabetes Therapy: A Real-Life Experience. Diabetes Ther 2024; 15:145-154. [PMID: 37883002 PMCID: PMC10786810 DOI: 10.1007/s13300-023-01489-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: 08/29/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Fixed ratio combination of insulin degludec and liraglutide (IDegLira) represents an option to revise inappropriate therapies in patients with poorly controlled type 2 diabetes. This study aimed to assess the pattern of use and 1-year effectiveness of IDegLira. METHODS 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. RESULTS Overall, 87 patients (mean age 73.9 ± 9.2 years, diabetes duration 18.2 ± 6.7 years, 62.1% men, HbA1c 8.3 ± 1.3%, BMI 30.4 ± 5.5 kg/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 ± 3.1 U (OHA group) to 24.1 ± 4.4 U (BB group). After 1 year, HbA1c was significantly reduced by 1.25% (95% CI - 1.48; - 1.03), FBG by 52.9 mg/dl, and body weight by 2.0 kg. Also, eGFR levels and lipid profile significantly improved. No severe hypoglycemia occurred. CONCLUSION 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.
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Affiliation(s)
- Isabella Romano
- U.O.S.V.D. Endocrinology/Diabetology, Cittadella della Salute, ASL Lecce, Lecce, Italy.
| | - Rosalia Serra
- U.O.S.V.D. Endocrinology/Diabetology, Cittadella della Salute, ASL Lecce, Lecce, Italy
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Builes-Montaño C, Wandurraga E, Ramírez A, Ordóñez JE. Simplification of Complex Insulin Regimens with IdegLira in People with Type 2 Diabetes: Literature Review and Clinical Recommendations. Diabetes Ther 2023; 14:1959-1976. [PMID: 37736786 PMCID: PMC10570232 DOI: 10.1007/s13300-023-01471-9] [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: 06/21/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION This study developed a simple algorithm based on clinical results described in medical literature and which allows one to simplify complex insulin regimes with IdegLira to avoid adverse events related to the complexity of some insulin treatments. METHODS We conducted a systematic review of the literature that allowed us to identify studies that evaluated the clinical result of simplifying complex insulin regimes. The authors reviewed the common factors these simpler regimes had, including the type of patients who used them. RESULTS We found nine clinical studies published between 2017 and 2022, eight performed in Europe and one in Latin America. The monitoring time of the studies ranged between 3 and 18 months. The size of the study populations was between 61 and 611 patients (the latter was in five countries). In all studies, HbA1c decreased by 0.6-1.7% and the weight decreased by 0.1-3.11 kg. CONCLUSIONS On the basis of the findings of these studies, we made some recommendations for clinical practice to simplify treatment. The results of these studies support an algorithm that simplifies the treatment of complex insulin regimens.
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Affiliation(s)
- C Builes-Montaño
- University of Antioquia Faculty of Medicine, Medellin, Colombia
- Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia
| | - E Wandurraga
- Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - A Ramírez
- Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia
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Vargas-Uricoechea H, Frias JP, Vargas-Sierra HD. Fixed-ratio Combinations (basal Insulin Plus GLP-1RA) In Type 2 Diabetes. an Analytical Review Of Pivotal Clinical Trials. Rev Diabet Stud 2023; 19:14-27. [PMID: 37185053 PMCID: PMC10082333 DOI: 10.1900/rds.2023.19.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
In type 2 diabetes, therapeutic failure to the oral anti diabetics is frequent, the use of schemes with basal insulin or with multiple doses of insulin (basal insulin and short-acting insulins) are a widely accepted way to intensify therapy. The use of GLP-1 receptor agonists is another intensification strategy. The fixedratio combinations with molecules such as insulin degludec + liraglutide, and insulin glargine + lixisenatide have proven useful in intensifying treatment of individuals with type 2 diabetes. The purpose of this review was to evaluate and analyze the results of pivotal studies with both fixed-ratio combinations in individuals with type 2 diabetes, finding that, they are capable of achieving better glycemic control when compared with each of its components separately (with a lower risk of hypoglycemia vs basal insulin and lower risk of gastrointestinal adverse effects vs GLP-1 receptor agonists) in various clinical scenarios, especially in individuals who do not achieve control with oral antidiabetics or who do not achieve control with basal insulin (associated with oral antidiabetics) or in those under management with GLP-1RA plus oral antidiabetics.
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Affiliation(s)
- Hernando Vargas-Uricoechea
- Metabolic Diseases Study Group, Department of Internal Medicine, Universidad del Cauca, Popayán-Colombia
| | | | - Hernando David Vargas-Sierra
- Metabolic Diseases Study Group, Department of Internal Medicine, Universidad del Cauca, Popayán-Colombia. Fellowship in Endocrinology, Diabetes and Metabolism, Universidad Pontificia Bolivariana, Medellín-Colombia
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Risovic I, Dumanovic MS, Bojic M, Djekic D. Direct comparison two fixed-ratio combination glucagon-like peptide receptor agonist and basal insulin on glycemic and non glycemic parameters in type 2 diabetes. BMC Endocr Disord 2023; 23:28. [PMID: 36726134 PMCID: PMC9890870 DOI: 10.1186/s12902-023-01282-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 01/25/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Two types of fixed-ratio combinations of basal insulin and a glucagon-like peptide-1 receptor agonist (GLP-1RA) have been approved for use in type 2 diabetes. One is insulin degludec/liraglutide (iDergLira), and the other is insulin glargine/lixisenatide (iGlarLixi). Direct comparisons between these two combination is not available. METHODS The retrospective study included 186 patients with type 2 diabetes mellitus (DM) with inadequate glycemic control on metformin and basal insulin (degludec, glargine 100, glargine 300) who were switched to fixed-ratio combination GLP-1 RA and basal insulin. Patients were divided into two groups based on the basal insulin before study: group I (n = 86) treated with degludec were switched to iDegLira and patients group II (n = 99), treated with glargine were switched to iGlarLixi. The aim of this study was to directly compare the effects between two fixed - ratio combination on glycemic parameters and non glycemic parameters. Follow up was 6 months. RESULTS Mean HbA1c decreased similarly (- 1.2% vs.-1.1%). Higher percentage patients in iDegLira group had reached the HbA1c < 7% after 6 months (22% vs. 18.2%, p < 0.05). The mean change in fasting plasma glucose (FPG) was comparable for the two groups, while mean decrease postprandial plasma glucose (PPG) level were lower in iGlarLixi group (2 vs 1.8 mmol/l, p > 0.05). Change in body weight was significant in iDegLira group (1.8 kg vs. 0.7 kg, p < 0.001). At the end of the study patients showed decrease in total cholesterol (TC) and low-density lipoprotein (LDL) for 0.2 mmol/L in iDegLira, 0.1 mmol/l in iGlarLixi, triglycerides decreased 0.3 mmol/l in both groups, high-density lipoprotein(HDL) increased 0.1 mm/l in iGlarLixi. CONCLUSION Our results showed that more patients with iDegLira had HbA1c less than 7% and these combination had better effect on weight loss. There was no difference observed in FPG and PPG, lipid profile and rate of hypoglycemia.
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Affiliation(s)
- Ivona Risovic
- Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina.
- Department of Endocrinology, University Clinical Center of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina.
| | - Mirjana Sumarac Dumanovic
- School of Medicine, University of Belgrade, Clinic for Endocrinology, Diabetes and Diseases of Metabolism, Belgrade, Serbia
| | - Mirjana Bojic
- Department of Endocrinology, University Clinical Center of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Danijel Djekic
- Department of Endocrinology, University Clinical Center of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
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Abusnana S, Al Awadi F, Aly H, Bashier A, Kumar Dhanwal D, Halasa T, Jallo M, Medina J, Singhal S. Switching to a fixed-ratio combination of insulin degludec/liraglutide (IDegLira) is associated with improved glycaemic control in a real-world population with type 2 diabetes mellitus in the United Arab Emirates: Results from the multicentre, prospective INTENSIFY study. Diabetes Res Clin Pract 2023; 196:110183. [PMID: 36436550 DOI: 10.1016/j.diabres.2022.110183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/01/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
AIM Investigate the effectiveness of IDegLira, a fixed-ratio combination of insulin degludec/liraglutide, in a real-world setting in patients with type 2 diabetes mellitus in the United Arab Emirates. METHODS This non-interventional study enrolled adults switching to IDegLira from basal insulin (BI) or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with/without concomitant oral antidiabetic drugs (OADs). Primary endpoint was change in HbA1c from baseline, assessed using a mixed model for repeated measurements. RESULTS Among 263 patients (BI ± OADs, n = 206; GLP-1 RA ± OADs, n = 57), mean baseline HbA1c was 9.29 % (78 mmol/mol). After 26 weeks, HbA1c was significantly reduced (BI ± OADs, -0.83 % [-9.0 mmol/mol] and GLP-1 RA ± OADs, -1.24 % [-13.5 mmol/mol]; both p < 0.0001). Fasting plasma glucose (FPG) was significantly reduced (-39.48 mg/dL [BI ± OADs] and -82.49 mg/dL [GLP-1 RA ± OADs]; both p < 0.0001). Before treatment initiation, 3/263 patients experienced ≥ 1 severe hypoglycaemic episode and 7/263 patients experienced ≥ 1 non-severe hypoglycaemic episode compared with 1/263 patients who had ≥ 1 severe and 1/263 who had ≥ 1 non-severe episode at end of study. Body weight decreased significantly among patients switching from BI ± OADs (-1.05 kg [p < 0.0001]). Treatment was well tolerated. CONCLUSIONS IDegLira significantly reduced HbA1c and FPG in this real-world setting, along with less frequent episodes of hypoglycaemia. Switching to IDegLira offers effective treatment intensification for type 2 diabetes patients with inadequate glycaemic control.
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Affiliation(s)
| | | | - Hazem Aly
- Novo Nordisk, Pharma Gulf, Dubai World Trade Centre, Dubai, United Arab Emirates
| | | | | | | | - Mahir Jallo
- Gulf Medical University & Thumbay University Hospital, Ajman, United Arab Emirates
| | | | - Sagar Singhal
- Novo Nordisk, Pharma Gulf, Dubai World Trade Centre, Dubai, United Arab Emirates
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McCrimmon RJ, Cheng AY, Galstyan G, Djaballah K, Li X, Coudert M, Frias JP. iGlarLixi versus basal plus Rapid-Acting insulin in adults with type 2 diabetes advancing from basal insulin therapy: The SoliSimplify Real-World study. Diabetes Obes Metab 2023; 25:68-77. [PMID: 36123617 PMCID: PMC10087837 DOI: 10.1111/dom.14844] [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: 06/09/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
AIM For people with suboptimally controlled type 2 diabetes (T2D) on basal insulin (BI), guidelines recommend several treatment advancement options. This study compared the clinical effectiveness of once-daily iGlarLixi versus a multiple-injection BI + rapid acting insulin (RAI) regimen in adults with T2D advancing from BI therapy in real-world clinical practice. MATERIALS AND METHODS Electronic medical records from the Observational Medical Outcomes Partnership (OMOP) database were analysed retrospectively using propensity score matching to compare therapy advancement with iGlarLixi or BI + RAI in US adults ≥18 years with T2D on BI who had ≥1 valid glycated haemoglobin (HbA1c) value at baseline and at the 6-month follow-up. The primary objective was non-inferiority of iGlarLixi to BI + RAI in HbA1c change from baseline to 6 months (margin 0.3%). RESULTS Propensity score matching generated cohorts with balanced baseline characteristics (N = 814 in each group). HbA1c reduction from baseline to 6 months with iGlarLixi was non-inferior to BI + RAI [mean difference (95% confidence interval): 0.1 (-0.1, 0.2)%; one-sided p = .0032]. At 6 months, weight gain was significantly lower with iGlarLixi than with BI + RAI [-0.8 (-1.3, -0.2) kg; two-sided p = .0069]. Achievement of HbA1c <7% without hypoglycaemia and weight gain were similar between groups [odds ratio (95% confidence interval): 1.15 (0.81, 1.63); p = .4280]. Hypoglycaemia was low in both groups, probably because of underreporting. CONCLUSIONS In real-world clinical practice, glycaemic outcomes 6 months after treatment advancement from BI are similar for people with T2D using iGlarLixi versus BI + RAI, with iGlarLixi leading to less weight gain.
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Affiliation(s)
- Rory J. McCrimmon
- Division of Systems Medicine, School of MedicineUniversity of DundeeDundeeUK
| | | | - Gagik Galstyan
- Diabetic Foot DepartmentEndocrinology Research CenterMoscowRussia
| | | | - Xuan Li
- SanofiBridgewaterNew JerseyUSA
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Tramunt B, Disse E, Chevalier N, Bordier L, Cazals L, Dupuy O, Marre M, Matar O, Meyer L, Noilhan C, Sanz C, Valensi P, Velayoudom FL, Gautier JF, Gourdy P. Initiation of the Fixed Combination IDegLira in Patients with Type 2 Diabetes on Prior Injectable Therapy: Insights from the EASY French Real-World Study. Diabetes Ther 2022; 13:1947-1963. [PMID: 36331712 PMCID: PMC9663793 DOI: 10.1007/s13300-022-01327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Combining basal insulin (BI) with glucagon-like peptide-1 receptor agonist (GLP-1RA) is recognized as a relevant option to optimize glucose control in type 2 diabetes (T2D). The EASY real-world study aimed to evaluate the modalities of initiation and the effectiveness of the insulin Degludec plus Liraglutide (IDegLira) fixed-ratio combination in the French health care system. METHODS A retrospective analysis included all patients with T2D and prior injectable therapy (GLP1-RA and/or insulin) who started treatment with IDegLira from September 2016 to December 2017 in 11 French diabetes centers. Baseline characteristics, reasons for IDegLira initiation, and modes of implementation were collected from the medical records. Changes in HbA1c and body weight were determined in patients with available follow-up data (nearest 6-month visit). RESULTS IDegLira was initiated in 629 patients previously treated with GLP-1RA alone (11.6%), insulin alone (31.5% including 16.5% with BI and 14.9% with multiple daily injections [MDI]) or a free combination of GLP-1RA and insulin (56.9% including 44.8% with BI and 12.1% with MDI), associated or not with oral agents. IDegLira starting dose (mean of 29 ± 11 dose steps) most often exceeded the recommended dose, and was significantly correlated with prior BI but not GLP-1RA dosage. At initiation, mean age, body mass index (BMI) and HbA1c were 60.1 ± 10.2 years, 33.4 ± 6.2 kg/m2 and 8.8 ± 1.7%, respectively. In 461 patients with available follow-up (median 178 days), HbA1c decreased in all subgroups submitted to treatment intensification (- 1.7 ± 1.8% [p < 0.0001], - 1.2 ± 1.8% [p < 0.001] and - 0.8 ± 1.8% [p = 0.0026] in patients with prior GLP-1RA, BI or MDI therapy, respectively) but also in those switching from BI and GLP-1RA free combination (- 0.2 ± 0.9%, p = 0.0419). Significant body weight gain occurred in patients previously treated with GLP-1RA alone (+ 1.5 ± 5.8 kg, p = 0.0572) or combined to BI (+ 1.0 ± 3.1 kg, p < 0.0001) while those on BI (- 1.4 ± 4.6 kg, p = 0.0139) or MDI (- 1.4 ± 5.0 kg, p = 0.0484) experienced weight loss. CONCLUSIONS While providing new information on the use of IDegLira in the French healthcare system, these data confirm the effectiveness of this fixed-ratio combination in the management of T2D.
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Affiliation(s)
- Blandine Tramunt
- Service de Diabétologie, Maladies Métaboliques et Nutrition, CHU et Université de Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France
- Institut des Maladies Métaboliques et Cardiovasculaires, UMR1297 INSERM/UT3, Toulouse, France
| | - Emmanuel Disse
- Service d'Endocrinologie, Diabète et Nutrition, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Chevalier
- Université Côte d'Azur, Centre Hospitalier Universitaire, INSERM U1065, C3M, Nice, France
| | - Lyse Bordier
- Service d'Endocrinologie, Hôpital d'instruction des Armées Begin, Saint-Mandé, France
| | - Laurent Cazals
- Service de Diabétologie, Maladies Métaboliques et Nutrition, CHU et Université de Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Olivier Dupuy
- Service de Diabétologie et Endocrinologie, Groupe Hospitalier Saint-Joseph, Paris, France
| | - Michel Marre
- Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Odette Matar
- Service d'Endocrinologie, Diabétologie et Nutrition, Hôpital Bichat, Paris, France
| | - Laurent Meyer
- Service d'Endocrinologie, Diabète et Maladies Métaboliques, CHU de Strasbourg, Strasbourg, France
| | - Chloé Noilhan
- Service de Diabétologie, Maladies Métaboliques et Nutrition, CHU et Université de Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Caroline Sanz
- Cabinet d'Endocrinologie, de Diabétologie et de Nutrition, Clinique Pasteur, Toulouse, France
| | - Paul Valensi
- Unit of Endocrinology, Diabetology and Nutrition, Jean Verdier Hospital, Paris Nord University, Bondy, France
| | | | - Jean-François Gautier
- Service de Diabétologie et d'Endocrinologie, Hôpital Lariboisière, AP-HP, Paris Cité, INSERM 1151, Paris, France
- Université Paris Cité, INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker Enfants Malades, 75015, Paris, France
| | - Pierre Gourdy
- Service de Diabétologie, Maladies Métaboliques et Nutrition, CHU et Université de Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France.
- Institut des Maladies Métaboliques et Cardiovasculaires, UMR1297 INSERM/UT3, Toulouse, France.
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11
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Mehta R, Billings LK, Liebl A, Vilsbøll T. Transitioning from basal-bolus or premix insulin therapy to a combination of basal insulin and glucagon-like peptide-1 receptor agonist in people with type 2 diabetes. Diabet Med 2022; 39:e14901. [PMID: 35708737 PMCID: PMC9542161 DOI: 10.1111/dme.14901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/29/2022] [Accepted: 06/14/2022] [Indexed: 11/27/2022]
Abstract
AIMS Two fixed-ratio combinations (FRCs) of basal insulin and glucagon-like peptide-1 receptor agonist (GLP-1RA) are available for once-daily use in adults with type 2 diabetes. We aimed to review the clinical evidence for the efficacy and safety of changing treatment from a basal-bolus insulin (BBI) regimen or a premix insulin to these combination treatments (fixed-ratio or loose) and provide expert opinion on the practicalities of making such a change. METHODS Relevant clinical and trial evidence and general review articles were identified through a literature review of ProQuest (comprising BIOSIS Previews®, Current Contents® Search, Embase® and MEDLINE®) for articles published between 2009 and 2021. RESULTS We identified nine articles reporting the results of FRCs, and seven articles reporting results of loose combinations of basal insulin and GLP-1RAs, in people who transitioned treatment from BBI or premix regimens. In most trials, combination treatment led to improved or equivalent glycaemic control, and a reduction in body weight or BMI, versus the original regimens. Some trials reported a reduction in total insulin dose. A few trials reported reduced or unchanged hypoglycaemia rates, or increased patient satisfaction, with combination therapy where these endpoints were examined. We provide guidance on transitioning of treatment and the patient types most likely to benefit. CONCLUSIONS In people not achieving glycaemic control with BBI or premix insulin regimens, an FRC or loose combination of basal insulin and GLP-1RA may improve control, decrease the risk of body weight gain or hypoglycaemia and reduce the complexity of treatment.
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Affiliation(s)
- Roopa Mehta
- Unidad de Investigación en Enfermedades Metabólicas, Departamento de Endocrinología y MetabolismoInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | - Liana K. Billings
- Division of Endocrinology and MetabolismNorthShore University HealthSystemSkokieIllinoisUSA
- Department of MedicineUniversity of Chicago Pritzker School of MedicineSkokieIllinoisUSA
| | - Andreas Liebl
- Center for Diabetes and Metabolism, m&i‐FachklinikBad HeilbrunnGermany
| | - Tina Vilsbøll
- Steno Diabetes Center Copenhagen, Gentofte HospitalGentofteDenmark
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12
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Fadini GP, Buzzetti R, Fittipaldi MR, D’Incau F, Da Porto A, Girelli A, Simoni L, Lastoria G, Consoli A. IDegLira for the Real-World Treatment of Type 2 Diabetes in Italy: Protocol and Interim Results from the REX Observational Study. Diabetes Ther 2022; 13:1483-1497. [PMID: 35717487 PMCID: PMC9309107 DOI: 10.1007/s13300-022-01287-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION IDegLira was shown to maintain glycemic control while reducing risk of hypoglycemia and body weight gain. The REX study was designed to generate real-world evidence on the use of IDegLira in Italian clinical practice in two different subgroups of patients, those switching to IDegLira from a basal insulin-supported oral therapy (BOT group) and those from a basal plus bolus insulin regimen (BB group). METHODS Adult patients with T2D diagnosed for at least 12 months and having started IDegLira 2-3 months prior to enrolment, coming from a BOT or BB regimen, were enrolled in this multicenter observational prospective cohort study conducted in 28 Italian centers. This paper presents the methodological framework of the REX study and provides the interim analysis results describing the patients' baseline characteristics and the clinical reasons for IDegLira treatment initiation. RESULTS Of the 360 patients enrolled in the REX study, 331 were considered eligible for this interim analysis, 76.4% in the BOT and 23.6% in the BB group. Mean (SD) HbA1c was 8.5% (1.4) in the BOT and 8.2% (1.7) in the BB group. The most common T2D complications were diabetic macroangiopathy and diabetic nephropathy in both groups. The median (interquartile range) insulin daily dose before IDegLira was 15.0 (10.0-20.0) units in the BOT group and 42 (30.0-52.0) in the BB group. Oral antidiabetics were taken by 98% and 51.3% of patients, respectively. The main reason for switching to IDegLira was the inadequate glycemic control in the BOT group (86% of patients), and the intent to simplify the treatment in the BB group (66.7%). CONCLUSIONS IdegLira is initiated after BOT in inadequately controlled patients to improve glycemic control, whereas in BB patients it is used to simplify the therapeutic regimen. Final results of the REX study will shed light on patients' outcomes after IdegLira treatment under routine clinical care.
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Affiliation(s)
- Gian Paolo Fadini
- Division of Metabolic Diseases, Department of Medicine, Padova Hospital, University of Padova, Padua, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome - Policlinico Umberto I Hospital, Rome, Italy
| | - Maria Rosa Fittipaldi
- Internal Medicine Unit, San Francesco d’Assisi Hospital, Oliveto Citra, Salerno Italy
| | - Ferruccio D’Incau
- Center of Diabetology, S. Maria del Prato Hospital, Feltre, Belluno Italy
| | - Andrea Da Porto
- Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy
| | - Angela Girelli
- Diabetes Care Unit, Spedali Civili Hospital, Brescia, Italy
| | - Lucia Simoni
- MediNeos Observational Research, IQVIA Company, Modena, Italy
| | | | - Agostino Consoli
- Department of Medicine and Aging Sciences, Centro Scienze Dell’Invecchiamento-Medicina Traslazionale (CeSI-MeT), University G. D’Annunzio, Chieti, Italy
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13
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Rizza S, Piciucchi G, Mavilio M, Longo S, Montagna M, Tatonetti R, Nucera A, Federici M. Effect of deprescribing in elderly patients with type 2 diabetes: iDegLira might improve quality of life. Biomed Pharmacother 2021; 144:112341. [PMID: 34678725 DOI: 10.1016/j.biopha.2021.112341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 12/21/2022] Open
Abstract
Older people with type 2 diabetes (T2D) often have several comorbidities and take multiple drugs. This study tested a deprescribing strategy in older T2D patients, replacing a hypoglycemic therapeutic scheme with a single drug combination (iDegLira). In this 6-month, real-world, single-arm, open interventional study, we enrolled patients ≥ 75 years with T2D taking ≥ 2 medications for diabetes. Patients on a basal-bolus insulin regimen (n = 13), on a basal-insulin regimen plus oral glucose-lowering drugs (n = 9), and those on oral glucose-lowering drugs (n = 18) were switched to daily iDegLira. The primary clinical endpoint of the study was an improvement in CASP-19 and/or DTSQ score after 6 months. We also evaluated changes in glucose metabolism, depression, cognitive function, level of independence, and markers of inflammation. Thirty-five patients (12 women, mean age=81.4 y) completed the protocol. Results shown here are given as estimated mean difference (95%CI). DTSQ score improved [11.08 (7.13/15.02); p = 0.0001], whereas CASP-19 did not after 6 months of iDegLira treatment. We observed reductions in BMI [- 0.81 (- 1.27/0.35); p < 0.001], fasting glucose [- 52.07 (- 77.26/26.88); p < 0.001], HbA1c [- 0.58 (- 1.08/0.08); p < 0.05], and TNF-α [- 1.83 (- 3.12/- 0.54); p = 0.007]. Activities of daily living and cognitive function score increased [p = 0.006 and p = 0.02], whereas depression score significantly decreased [p = 0.02]. Notably, no patient reported episodes of severe hypoglycemia after initiation of iDegLira treatment. Among older patients with T2D, deprescribing using a single dose of iDegLira resulted in a greater likelihood of improving health and quality of life. Although our data indicate the effectiveness and safety of this approach, it must be confirmed in larger studies.
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Affiliation(s)
- Stefano Rizza
- Department of System Medicine, University of Rome Tor Vergata, Italy.
| | - Giacomo Piciucchi
- Department of System Medicine, University of Rome Tor Vergata, Italy
| | - Maria Mavilio
- Department of System Medicine, University of Rome Tor Vergata, Italy
| | - Susanna Longo
- Department of System Medicine, University of Rome Tor Vergata, Italy
| | - Martina Montagna
- Department of System Medicine, University of Rome Tor Vergata, Italy
| | | | - Alessandro Nucera
- Department of System Medicine, University of Rome Tor Vergata, Italy
| | - Massimo Federici
- Department of System Medicine, University of Rome Tor Vergata, Italy
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