Real-world data confirm benefits of IDegLira
medwireNews: IDegLira, which combines the basal insulin degludec with the glucagon-like peptide (GLP)-1 receptor agonist liraglutide, improves glycemic control within 6 months of initiation irrespective of previous therapy, real-world study data show.
The treatment was also associated with a low risk for hypoglycemia, no weight gain, and a reduction in the need for other glucose-lowering therapies, Hermione Price (The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Southern Health NHS Foundation Trust, Bournemouth, UK) and colleagues report in Diabetes, Obesity and Metabolism.
Six months prior to IDegLira initiation, the 611 participants with type 2 diabetes were receiving a broad variety of treatments, including non-injectable therapies (19%), basal insulin (19%), GLP-1 receptor agonists (10%), a free combination of insulin and GLP-1 receptor agonists (24%), and multiple daily insulin injections (MDI; 28%), all with or without oral antidiabetic drugs.
This broad range of therapies “suggests that IDegLira was not always introduced as early in the treatment pathway as has been investigated in the DUAL clinical trial programme and as is recommended in the prescribing information,” Price et al remark.
They suggest this might be because physicians prefer to try out this relatively recently approved agent in patients who have no other treatment options before offering it to less severe cases.
After 6 months of treatment with IDegLira, the review of participants’ medical records showed that glycated hemoglobin (HbA1c) fell by a significant 0.9% in the overall population, from 8.4% to 7.5%. At 12 months, the reduction from baseline was 0.6%.
Similar results were observed across all baseline therapy subgroups, with the greatest impact – an HbA1c reduction of 1.6% – observed among those who had been taking non-injectable therapies.
The researchers point out that the improvement in glycemic control occurred with “moderate” mean IDegLira doses of 22 dose steps at initiation, and 30 and 32 dose steps at 6 and 12 months follow-up, respectively.
Bodyweight fell by a significant 0.7 kg overall at 6 months versus baseline. However, this was mainly driven by a significant 2.4 kg weight loss in the MDI subgroup, which Price et al attribute to a significant reduction in total insulin dose in this subgroup.
In the 6 months before IDegLira initiation hypoglycemia occurred at a rate of 0.28 events per patient–year. This fell by a significant 82% to 0.06 events per patient–year in the 6-months after IDegLira initiation.
The team also found that 32% of the 481 patients using at least one oral antidiabetic agent at baseline discontinued at least one of these treatments following IDegLira initiation, while the mean GLP-1 receptor agonist dose fell significantly and total daily insulin dose was reduced by 9.2 units.
Price and co-authors conclude that their findings are “pertinent to physicians who are considering the most appropriate therapy for patients who are failing to achieve glycaemic control targets or struggling with side effects such as weight gain and hypoglycaemia.”
By Laura Cowen
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