Drug combination helps patients with type 2 diabetes maintain their blood glucose goals

For diabetic patients, it is important to lower and maintain low blood glucose levels to minimize the risk of long-term complications such as nerve damage, kidney damage, increased risk of heart disease, eye problems, etc. In a randomized, multi-center clinical trial sponsored by Novo Nordisk, researchers studied blood glucose results in patients badigned to insulin (insulin glargine, IGlar U100) or insulin degludec plus liraglutide (IDegLira) , a combination of insulin and an additional medication. help control blood sugar The global study team found that participants receiving IDegLira were better able to meet their glucose goals and stayed longer compared to those badigned to receive IGlar. The results are presented today at the scientific sessions of the American Diabetes Association and published simultaneously in The Diabetes Lancet & Endocrinology.

"We think this reflects a longer-lasting effect of IDegLira compared to IGlar, probably related to the complementary roles and physiological effects in the formulation of the combination," said Vanita R. Aroda, corresponding author and global investigator signatory. , Specialist of the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women's Hospital.

The study, known as DUAL VIII (Sustainability of insulin degludec plus liraglutide versus insulin glargine U100 as the initial injectable treatment in type 2 diabetes), was an international phase 3b study, multicenter and open, lasting 104 weeks. It included 1,012 insulin-naive patients, aged 18 years and older, with an HbA1c level between 7 and 11% and a BMI equal to or greater than 20 kg / m² at stable doses of 39, oral antidiabetic agents. Patients were randomized to take insulin glargine at 100 units / mL (IGlar U100) or IDegLira, which contains a GLP-1 receptor badog, a molecule similar to a natural compound reducing glucose levels in the body. blood. IDegLira and IGlar were administered as injections once a day. The primary endpoint was the time required for intensification of treatment.

Patients in the IDegLira group had significantly more time to intensify their treatment than those in the IGlar group. The researchers reported a more effective reduction in blood glucose, less weight gain and a lower risk of hypoglycemia or hypoglycemia during the 104 weeks of use of the combination ( IDegLira) compared to basal insulin alone (IGlar). No new safety or tolerability issues were reported during the test.

In their article, Aroda and his colleagues describe the clinical inertia that surrounds the treatment of diabetes. Concerns about weight gain, hypoglycemia and the fear of injectables can prevent patients from better controlling their blood sugar levels. Although IDegLira and IGlar were administered daily as injections, IDegLira showed better results without resorting to a separate supplemental injection.

"IDegLira has shown greater durability than IGlar U100 to reach and keep patients at glycemic targets longer, minimizing the need for additional treatment, while reducing the side effects often badociated with insulin-only therapy" , write the authors. "Taken together, the DUAL VIII data illustrates the potential benefits of a combined insulin-GLP-1RA approach, such as IDegLira, as the first injectable treatment."