Simplifying Complex Insulin Regimens While Preserving Good Glycemic Control in Type 2 Diabetes

Zoltán Taybani; Balázs Bótyik; Mónika Katkó; András Gyimesi; Tamás Várkonyi

doi:10.1007/s13300-019-0673-8

Simplifying Complex Insulin Regimens While Preserving Good Glycemic Control in Type 2 Diabetes

Diabetes Ther. 2019 Oct;10(5):1869-1878. doi: 10.1007/s13300-019-0673-8. Epub 2019 Jul 25.

Authors

Zoltán Taybani¹, Balázs Bótyik², Mónika Katkó³, András Gyimesi², Tamás Várkonyi⁴

Affiliations

¹ 1st Department of Endocrinology, Dr. Réthy Pál Member Hospital, Békés County Central Hospital, Gyulai street 18, Békéscsaba, 5600, Hungary. taybanizoltan@gmail.com.
² 1st Department of Endocrinology, Dr. Réthy Pál Member Hospital, Békés County Central Hospital, Gyulai street 18, Békéscsaba, 5600, Hungary.
³ Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary.
⁴ 1st Department of Internal Medicine, University of Szeged, Korányi fasor 8, Szeged, 6720, Hungary.

Abstract

Introduction: Type 2 diabetic patients suffering from severe hyperglycemia are often assigned a regimen involving multiple daily injections (MDI) of insulin. If the glucose toxicity resolves, the regimen can potentially be simplified, but there are no guidelines for this, and many patients are left on the MDI regimen. We aimed to prospectively examine the safety and efficacy of switching from MDI to once-daily IDegLira, a fixed-ratio combination of insulin degludec and liraglutide, in relatively well controlled (HbA1c ≤ 7.5%) subjects with type 2 diabetes on a low total daily insulin dose (TDD).

Methods: 62 adults with type 2 diabetes (baseline age 64.06 ± 10.24 years, HbA_1c 6.42 ± 0.68%, BMI 33.53 ± 6.90 kg/m², body weight 93.81 ± 19.26 kg, TDD 43.31 ± 10.99 IU/day, insulin requirement 0.47 ± 0.13 IU/kg, duration of diabetes 10.84 ± 7.50 years, mean ± SD) treated with MDI ± metformin were enrolled in our study. Previous insulins were stopped and once-daily IDegLira was started. IDegLira was titrated by the patients to achieve a self-measured pre-breakfast blood glucose concentration of < 6 mmol/L.

Results: After a mean follow-up period of 99.2 days, mean HbA_1c had decreased by 0.30% to 6.12 ± 0.65% (p < 0.0001), body weight had decreased by 3.11 kg to 90.70 ± 19.12 kg (p < 0.0001), and BMI had reduced to 32.39 ± 6.71 kg/m² (p < 0.0001). After 3 months of treatment, the mean dose of IDegLira was 20.76 ± 6.60 units and the mean insulin requirement had decreased to 0.23 ± 0.08 IU/kg. IDegLira ± metformin combination therapy was found to be safe and generally well tolerated. During the month before the baseline visit, 28 patients (45%) had at least one episode of documented or symptomatic hypoglycemia, while only 6 (9.67%) patients reported a total of 13 documented episodes during the follow-up.

Conclusion: In everyday clinical practice, switching from low-dose MDI to IDegLira in patients with well-controlled type 2 diabetes is safe, may result in weight loss and similar or better glycemic control, and substantially reduces the insulin requirement. Simplifying complex treatment regimens decreases treatment burden and may improve adherence to therapy.

Clinical trial number: NCT04020445.

Keywords: Deintensification; IDegLira; Overtreatment; Simplification; Type 2 diabetes.

Associated data

ClinicalTrials.gov/NCT04020445