Metabolic Control and Adherence to Therapy in Type 2 Diabetes Mellitus Patients Using IDegLira in a Real-World Setting

Cheli Melzer-Cohen; Gabriel Chodick; Shiran Naftelberg; Naim Shehadeh; Avraham Karasik

doi:10.1007/s13300-019-00725-9

Metabolic Control and Adherence to Therapy in Type 2 Diabetes Mellitus Patients Using IDegLira in a Real-World Setting

Diabetes Ther. 2020 Jan;11(1):185-196. doi: 10.1007/s13300-019-00725-9. Epub 2019 Dec 5.

Authors

Cheli Melzer-Cohen¹, Gabriel Chodick^{1

2}, Shiran Naftelberg³, Naim Shehadeh⁴, Avraham Karasik^{5

6

7}

Affiliations

¹ Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.
² Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
³ Medical Affairs, Novo Nordisk, Kefar Sava, Israel.
⁴ Institute of Endocrinology, Diabetes and Metabolism, Rambam Campus, Haifa, Israel.
⁵ Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel. karasik@post.tau.ac.il.
⁶ Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. karasik@post.tau.ac.il.
⁷ Institute of Endocrinology,, Chaim Sheba Medical Center, Tel Hashomer, Israel. karasik@post.tau.ac.il.

Abstract

Introduction: Insulin degludec/liraglutide (IDegLira) is a fixed-ratio combination (FRC) of basal insulin and glucagon-like protein-1 receptor agonist (GLP-1 RA) that has demonstrated glycemic and metabolic benefits in patients with type 2 diabetes mellitus (T2DM) in both randomized controlled trials and real-world studies. The impact of adherence to this medication and its effect on patients with T2DM who switch from loose-dose combination therapy to a FRC of insulin and GLP-1RA have not yet been reported. We have examined the metabolic effects and adherence to this medication in a real-life setting, in T2DM patients who initiated IDegLira therapy after being treated with other glucose-lowering drugs.

Methods: This is a retrospective observational study of adult T2DM patients managed by the Maccabi Healthcare Services (Israel) who initiated IDegLira and persisted with therapy for 180 days between July 2017 and August 2018. Mean glycated hemoglobin (HbA_1c), body weight change, metabolic parameters, dose and proportion of days covered (PDC) by IDegLira were recorded from initiation to after 180 days of therapy.

Results: A total of 413 patients who persisted with IDegLira therapy for at least 180 days were evaluated as a per protocol group. A significant mean reduction in HbA_1c of 0.65% (95% confidence limits [CL] - 0.78, - 0.52; P < 0.001) was observed at 180 days compared with baseline. IDegLira therapy led to a significant reduction in HbA_1c in patients previously treated with different background combinations of glucose-lowering drugs before being started on IDegLira. The largest group (n = 247) comprised those who switched from a loose-dose combination therapy of insulin and GLP-1 RA as injectable components given alone to the IDegLira FRC. In this group, HbA_1c was reduced by 0.42% (95% CL - 0.57, - 0.27; P < 0.001) and in parallel the PDC of insulin and GLP-1 RA increased from a median of 60% (interquartile range [IQR] 34.4-79.4) in the 180 days prior to IDegLira initiation to 77.8% (IQR 65.6-90.0) in the 180 days after initiation.

Conclusion: In a real-world setting, the use of IDegLira was associated with improved glycemic control and adherence to therapy.

Keywords: Adherence; Fixed ratio combination; IDegLira; Type 2 diabetes.