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Effectiveness of Insulin Regimens For Patients With Uncontrolled Type 2 Diabetes

Use of degludec/liraglutide vs glargine injections focus of study.

In a study appearing in the March 1 issue of JAMA, John B. Buse, M.D., Ph.D., of the University of North Carolina School of Medicine, Chapel Hill, and colleagues compared the outcomes of once-daily injection of basal insulin (glargine) vs a once-daily injection of the combination of basal insulin degludec and the glucagon-like peptide-1 receptor agonist liraglutide in patients with uncontrolled type 2 diabetes.

Achieving optimal glucose control is a challenge for the majority of patients with type 2 diabetes, with less than one-third of patients treated with basal insulin reaching a glycated hemoglobin (HbA1c) level of less than 7 percent. In this trial, 557 patients with uncontrolled diabetes were randomly assigned to degludec/liraglutide (n = 278) or glargine (n = 279). The 26-week trial was conducted at 75 centers in 10 countries.

The researchers found that HbA1c level reduction was greater with degludec/liraglutide vs glargine, and met criteria for noninferiority (not worse than). Secondary analysis indicated a greater HbA1c level reduction with degludec/liraglutide. Analyses also indicated that degludec/liraglutide was associated with weight loss compared with weight gain with glargine, and a lower rate of hypoglycemia. Overall and serious adverse event rates were similar in the 2 groups, except for more nonserious gastrointestinal adverse events reported with degludec/liraglutide.

“Further research is indicated to evaluate the durability of the effects of degludec/liraglutide in longer-term studies, in clinical practice, and to assess whether patients and physicians consider degludec/liraglutide a suitable treatment option to overcome barriers to treatment intensification,” the authors write.

Practice Pearls:

  • HbA1c level reduction was greater with degludec/liraglutide vs glargine, and met criteria for noninferiority (not worse than).
  • Degludec/liraglutide was associated with weight loss compared with weight gain with glargine, and a lower rate of hypoglycemia.
  • Degludec/liraglutide was associated with a lower rate of hypoglycemia.

Researched and prepared by Javeria Fayyaz, Doctor of Pharmacy Candidate LECOM College of  Pharmacy, reviewed by Dave Joffe, BSPharm, CDE

 

doi:10.1001/jama. Feb.2016.1252