Combination Degludec/Liraglutide Reduced HgA1C and Insulin Side Effects in Type 2 Diabetes

MedicalResearch.com Interview with:

Dr. John Buse MD Ph.D Professor, Medicine Director, Diabetes Care Center Chief, Division of Endocrinology Executive Associate Dean, Clinical Research University of North Carolina School of Medicine

Dr. John Buse

Dr. John Buse MD Ph.D
Professor, Medicine
Director, Diabetes Care Center
Chief, Division of Endocrinology
Executive Associate Dean, Clinical Research
University of North Carolina School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Buse: Degludec is an longer acting basal insulin analog recently approved in the US.  Liraglutide is a once-daily GLP-1 receptor agonist.  Both are among the most powerful glucose lowering drugs available in the setting of type 2 diabetes.  They have very different properties.  Degludec is best at lowering fasting glucose. Liraglutide has effects on postprandial glucose as well.  The major side effects of degludec are hypoglycemia and weight gain. Liraglutide on the other hand has not an inherent effect to cause hypoglycemia and does promote weight loss.  Liraglutide does cause nausea and in fewer patients vomiting in a dose dependent manner. In developing the fixed dose combination the idea was to amplify glucose lowering efficacy and minimize the adverse effects of both components.  Prior studies have basically shown that this has been accomplished.  In this study we looked at the very common clinical scenario of the patient with type 2 diabetes inadequately controlled on basal insulin glargine and asked the question of whether switching from glargine to IDegLira (the combination product) would do better than continued titration of glargine.

Medical Research: What should clinicians and patients take away from your report?

Dr. Buse: The study robustly demonstrated that IDegLira was able to reduce Hemoglobin A1C substantially more than continued titration of glargine and furthermore achieve that greater lowering of A1C with less hypoglycemia and weight loss instead of weight gain.  Further nausea appeared to be mitigated in comparison to other studies in which liraglutide has been used.  Thus, it seems that this combination product under review at the FDA may play an important role in enhancing glycemic control in those toughest patients who are uncontrolled already treated with glargine.  The titration scheme was easy to do – increasing or decreasing the dose by 2 “dose clicks” twice a week based on average fasting glucose aiming for a range of 72-90 mg/d.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Buse: There is a study to look at the other alternative approach in this population, namely adding rapid acting insulin with meals.

Medical Research: Is there anything else you would like to add?

Dr. Buse: No.  It is an exciting time in diabetes therapeutics.  We have truly amazing tools to control glycemia. The only issue is how to get the right drugs to the right people in the context of a robust educational program targeting behavior change for diet, activity and drug titration based on glucose monitoring. Essentially everyone with type 2 diabetes can achieve adequate control of diabetes to avoid its long term complications in theory.  There is a lot of work to do in practice vis-à-vis health policy and access. 

Citation:

Lingvay I, Manghi F, García-Hernández P, et al. Effect of Insulin Glargine Up-titration vs Insulin Degludec/Liraglutide on Glycated Hemoglobin Levels in Patients With Uncontrolled Type 2 Diabetes: The DUAL V Randomized Clinical Trial. JAMA.2016;315(9):898-907. doi:10.1001/jama.2016.1252.
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Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions 

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Dr. John Buse MD Ph.D (2016). Combination Insulin Degludec/Liraglutide Reduced HgA1C and Insulin Side Effects in Type 2 Diabetes 

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