Initiation of the Fixed Combination IDegLira in Patients with Type 2 Diabetes on Prior Injectable Therapy: Insights from the EASY French Real-World Study

Blandine Tramunt; Emmanuel Disse; Nicolas Chevalier; Lyse Bordier; Laurent Cazals; Olivier Dupuy; Michel Marre; Odette Matar; Laurent Meyer; Chloé Noilhan; Caroline Sanz; Paul Valensi; Fritz-Line Velayoudom; Jean-François Gautier; Pierre Gourdy

doi:10.1007/s13300-022-01327-8

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 Dec;13(11-12):1947-1963. doi: 10.1007/s13300-022-01327-8. Epub 2022 Nov 4.

Authors

Blandine Tramunt^{1

2}, Emmanuel Disse³, Nicolas Chevalier⁴, Lyse Bordier⁵, Laurent Cazals¹, Olivier Dupuy⁶, Michel Marre⁷, Odette Matar⁸, Laurent Meyer⁹, Chloé Noilhan¹, Caroline Sanz¹⁰, Paul Valensi¹¹, Fritz-Line Velayoudom¹², Jean-François Gautier^{13

14}, Pierre Gourdy^{15

16}

Affiliations

¹ Service de Diabétologie, Maladies Métaboliques et Nutrition, CHU et Université de Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France.
² Institut des Maladies Métaboliques et Cardiovasculaires, UMR1297 INSERM/UT3, Toulouse, France.
³ Service d'Endocrinologie, Diabète et Nutrition, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.
⁴ Université Côte d'Azur, Centre Hospitalier Universitaire, INSERM U1065, C3M, Nice, France.
⁵ Service d'Endocrinologie, Hôpital d'instruction des Armées Begin, Saint-Mandé, France.
⁶ Service de Diabétologie et Endocrinologie, Groupe Hospitalier Saint-Joseph, Paris, France.
⁷ Clinique Ambroise Paré, Neuilly-sur-Seine, France.
⁸ Service d'Endocrinologie, Diabétologie et Nutrition, Hôpital Bichat, Paris, France.
⁹ Service d'Endocrinologie, Diabète et Maladies Métaboliques, CHU de Strasbourg, Strasbourg, France.
¹⁰ Cabinet d'Endocrinologie, de Diabétologie et de Nutrition, Clinique Pasteur, Toulouse, France.
¹¹ Unit of Endocrinology, Diabetology and Nutrition, Jean Verdier Hospital, Paris Nord University, Bondy, France.
¹² Service d'Endocrinologie-Diabétologie, CHU de Guadeloupe, Pointe-À-Pitre, France.
¹³ Service de Diabétologie et d'Endocrinologie, Hôpital Lariboisière, AP-HP, Paris Cité, INSERM 1151, Paris, France.
¹⁴ Université Paris Cité, INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker Enfants Malades, 75015, Paris, France.
¹⁵ Service de Diabétologie, Maladies Métaboliques et Nutrition, CHU et Université de Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France. gourdy.p@chu-toulouse.fr.
¹⁶ Institut des Maladies Métaboliques et Cardiovasculaires, UMR1297 INSERM/UT3, Toulouse, France. gourdy.p@chu-toulouse.fr.

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 HbA_1c 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 HbA_1c 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), HbA_1c 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.

Keywords: Fixed-ratio combination; GLP-1RA; Insulin; Real-world study; Type 2 diabetes.