Efficacy of IDegLira Versus IDegAsp Therapy in Patients with Type 2 Diabetes: A Randomized Crossover Study by isCGM

Abstract

Introduction We aimed to compare the efficacy of insulin degludec/insulin aspart (IDegAsp) and insulin degludec/liraglutide (IDegLira) in controlling glucose fluctuation and suppressing postprandial glucose levels using intermittently scanned continuous glucose monitoring. Methods Twenty-four patients with type 2 diabetes mellitus were randomly allocated to receive either IDegLira or IDegAsp followed by IDegAsp or IDegLira, respectively. A crossover study was conducted with intermittently scanned continuous glucose monitoring. We compared the postprandial blood glucose level, time in range, and time below range from a 3-day intermittently scanned continuous glucose monitoring period for each treatment group. Results The time in range was significantly higher in IDegLira than in IDegAsp. Postprandial glucose levels 90 and 120 min after breakfast and 60, 90, and 120 min after lunch were significantly lower for IDegLira than for IDegAsp. However, postprandial glucose levels 90 and 120 min after supper were significantly lower for IDegAsp than for IDegLira. There was no significant difference in the time below range between IDegLira and IDegAsp. Conclusion IDegLira was more effective in treating type 2 diabetes mellitus than IDegAsp, as indicated by a higher time in range and lower postprandial glucose level at breakfast and lunch. This study was registered with the University Hospital Medical Information Network Clinical Trial Registry (UMIN 000039221). Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02138-w.

Comparison of efficacy and safety of insulin degludec/liraglutide and insulin glargine U‐100/lixisenatide in individuals with type 2 diabetes mellitus using professional continuous glucose monitoring

“…Analysis of CGM data with a time in range of 70–180 mg/dL confirmed a TIR of 70% with an HbA1c level of 7.0% 19 ; thus, a time in range of >70% is recommended for treatment with CGM 8 . In our previous study, TIR accounted for very high percentages of IGlarLixi and IGlu treatment (93.1%) 17 and IDegLira treatment (86.3%) 18 . In actual clinical practice, diabetes injection therapy is often initiated in an outpatient setting.…”

“…A significant negative correlation was identified between C‐peptide immunoreactivity (CPR) values and IGlu dosage 17 . Furthermore, the authors compared IDegLira and insulin degludec/insulin aspart (IDegAsp) injected pre‐supper and reported that IDegLira had a significantly higher TIR than IDegAsp, suppressed postprandial glucose levels at breakfast and lunch, and had a significant negative correlation with a 24 h coefficient of variation (CV) of glycemic variability (GV) and C‐peptide index (CPI) 18 . Analysis of CGM data with a time in range of 70–180 mg/dL confirmed a TIR of 70% with an HbA1c level of 7.0% 19 ; thus, a time in range of >70% is recommended for treatment with CGM 8 .…”

“…No direct comparative reports are available for the introduction of injection therapy with IGlarLixi and IDegLira in outpatient clinical settings, and the ideal patient profile for each of these fixed‐ratio combinations is not clearly defined. In previous studies, the effectiveness and safety of fixed‐ratio combinations were suggested to be related to endogenous insulin secretion capacity 17 , 18 . Therefore, this study aimed to determine indicators for selecting the two fixed‐ratio combinations using proCGM to clarify the relationship between time in range and endogenous insulin secretion capacity.…”

Fixed-ratio combinations of basal insulin and glucagon-like peptide-1 receptor agonists as a promising strategy for treating diabetes

“…One motivation to use injections containing a GLP-1RA component is to reduce glucose fluctuations, which is difficult using basal insulin regimens. Differences in the effects of the two step-up regimens (switching from basal insulin to once-daily IDegAsp or IDegLira) on glycemic variability were confirmed in an RCT using intermittently scanned continuous glucose monitoring by Kawaguchi et al [ 51 ]. They demonstrated that a step up to IDegLira was associated with a longer period of time in the target glucose range (3.9–10.0 mmol/L) and a lower glucose variability after breakfast and lunch than the use of IDegAsp.…”

“…Importantly, Kawaguchi et al [ 51 ] showed that endogenous insulin secretary capacity was important to maximize the efficacy of such FRCs[ 51 ]. Beta-cell function declines over time in people with T2D[ 54 ].…”