Expert Panel Guidance and Narrative Review of Treatment Simplification of Complex Insulin Regimens to Improve Outcomes in Type 2 Diabetes

Jude, Edward B.; Małecki, Maciej T.; Huelgas, Ricardo Gómez; Prázný, Martin; Snoek, Frank J.; Tankova, Tsvetalina; Giugliano, Dario; Khunti, Kamlesh

doi:10.1007/s13300-022-01222-2

Cited by 26 publications

(30 citation statements)

References 78 publications

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“…Furthermore, in the older group, most of the ITP are treated with basal and prandial insulin and maintain levels of HbA1c below 7.5% (inverse therapeutic inertia) 29 , so they may need a simplification of the treatment pattern used 30 . Despite everything, the estimated doses per annual consumption of long-acting insulin are unexpectedly low, suggesting a possible lack of adherence to insulin treatment 31 .…”

Section: Discussionmentioning

confidence: 99%

A population-based analysis of insulin management patterns in a province of southern Spain (2014-2018)

Escribano‐Serrano¹,

Jiménez-Varo²,

Méndez-Esteban³

et al. 2022

SJMED

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Aim:The aim of this study was to analyze the patterns of insulin consumption between 2014 and 2018 in Cádiz. Methods: This study was a cross-sectional retrospective study. All people that used any insulin were included in the study. The Cadiz Diabetes Database includes data on yearly anti-diabetic prescriptions and hemoglobin A1c (HbA1c) levels. Results:The prevalence of insulin-users was 2.15%. More prevalent in women and increased with age (0.18% in the 0-15-year-old group to 8.53% in the > 75-year-old group); insulin' users represent 28.8% of the total population with diabetes mellitus treatments. Seventy percent of insulin-treated patients (ITP) were over 60 years old. Long-acting insulin was consumed by 79% of users, representing 55% of the total insulin types consumed. Glargine was the most consumed (4,654,000 defined daily dose and valuing > 7.000.000€ in 2018). In > 75-year-old group, 50% were treated with long-acting and fast-acting insulin combinations. Annual HbA1c was determined for two out of three ITP and 37% of these had Hb1Ac < 7% (53 mmol/mol). Conclusions: The Cadiz population presents a high consumption of insulin. Insulin prescription patterns have changed during the study. Long-acting insulins, especially Glargine (alone or in combination), are the most widely used types of insulin. In the group of elderly patients, the patterns found are not in line with the current recommendations. ITP in Cadiz has a poor glycemic (median HbA1c 7.84%) control and a low amount of Hb1Ac determinations.

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Section: Discussionmentioning

confidence: 99%

A population-based analysis of insulin management patterns in a province of southern Spain (2014-2018)

Escribano‐Serrano¹,

Jiménez-Varo²,

Méndez-Esteban³

et al. 2022

SJMED

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“…In line with the findings from the BEYOND trial, the ENSURE study, where a subgroup of patients was previously treated with complex regimens such as basal bolus schemes, suggests that a simplification of intensive insulin treatment is possible and even advisable for patients with T2D [20]. FRC can reduce hypoglycemia risk and number of daily injections, thus improving medication adherence and quality of life [24,25].…”

Section: Implications For Research and Clinical Practicementioning

confidence: 84%

Effectiveness, Safety, and Appropriateness in the Use of the Fixed-Ratio Combination of Insulin Glargine and Lixisenatide in Type 2 Diabetes: The ENSURE Retrospective Real-World Study

Candido

Modugno²,

Larosa³

et al. 2022

Diabetes Ther

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Introduction: Pivotal trials documented glycemic benefits of fixed-ratio combination of insulin glargine 100 U/mL and lixisenatide (iGlarLixi), with no weight gain and low hypoglycemia risk in type 2 diabetes (T2D). This study aimed at assessing effectiveness and patterns of use of iGlarLixi in a real-world setting. Methods: This was a retrospective, multicenter, study, based on electronic medical records. All patients initiating iGlarLixi from May 2018 to July 2020 were considered.Results: Overall, 25 centers provided data on 675 patients initiating iGlarLixi with the following characteristics: age 66.4 ± 10.1 years, 54.2% men, T2D duration 15.5 ± 11.5 years, HbA1c 8.6 ± 1.4%, body mass index (BMI) 30.8 ± 5.3 kg/m 2 , 45.1% already treated with basal insulin, and 21.9% with basal bolus (± oral hypoglycemic agents). Metformin and sodium-glucose cotransporter-2 inhibitors were used in 76.0% and 0.9% of patients, respectively. Combinations of iGlarLixi with other glucose-lowering drugs such as sulfonylureas or short-acting insulin were found in 32.4% of patients. Effectiveness of iGlarLixi (N = 184) showed that HbA1c declined by 0.77% [95% confidence interval (CI) -1.00, -0.54] after 6 months. In combination with metformin and/or SGLT-2i (N = 117), HbA1c declined by -0.92% (95% CI -1.22, -0.62) and weight significantly decreased by 1.21 kg. iGlarLixi dose was suboptimally titrated. Safety data (N = 171) showed incidence rates of blood glucose B 70 and \ 54 mg/mL of 0.26 and 0.05 events per person-month during 6 months, respectively, with a risk reduction of about 75% with respect the 6 months before iGlarLixi initiation. No severe hypoglycemia was reported. Conclusion: In adults with T2D, effectiveness and safety of iGlarLixi were documented in a real-world setting; appropriateness of use and adequate titration should be urgently improved so that clinical practice outcomes become more comparable to clinical trials results. Further real-

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“…Furthermore, as prandial insulin analogues contain rapid or intermediate‐acting insulin analogues associated with considerable glycaemic variability, there is a relatively high risk of hypoglycaemia 21 . Real‐world data show that only 17% to 24% of people older than 50 years treated with basal‐bolus insulin achieve their glycaemic goals, 22 suggesting that complex regimens are associated with a substantial burden and/or fear of hypoglycaemia 20,23‐26 . Self‐management is seen to improve with less frequent, once‐daily insulin dosing and pen injectors for convenient insulin delivery, correlating with greater treatment adherence and persistance 23,27 .…”

Section: Discussionmentioning

confidence: 99%

“…20,[23][24][25][26] Selfmanagement is seen to improve with less frequent, once-daily insulin dosing and pen injectors for convenient insulin delivery, correlating with greater treatment adherence and persistance. 23,27 Overall, patients are responsive to treatment simplification.…”

Section: Hypoglycaemia and Adverse Eventsmentioning

confidence: 99%

Advancing type 2 diabetes therapy with iGlarLixi in older people: Pooled analysis of four randomized controlled trials

Munshi,

Ritzel,

Jude

et al. 2023

Diabetes Obesity Metabolism

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AimTo assess the efficacy and safety of iGlarLixi in older people (≥65 years) with type 2 diabetes (T2D) advancing or switching from oral agents, a glucagon‐like peptide‐1 receptor agonist (GLP‐1RA), or basal insulin.Materials and MethodsThe data of participants aged <65 years and ≥65 years from four LixiLan trials (LixiLan‐O, LixiLan‐G, LixiLan‐L, SoliMix) were evaluated over 26 or 30 weeks.ResultsParticipants aged <65/≥65 years (n = 1039/n = 497) had a mean baseline body mass index of 31.4 and 30.7 kg/m2 and glycated haemoglobin (HbA1c) concentration of 66 mmol/mol (8.2%) and 65 mmol/mol (8.1%), respectively. Least squares mean HbA1c change from baseline to end of treatment (EOT) was −14.32 mmol/mol (−1.31%) (95% confidence interval [CI] −14.97, −13.77 [−1.37%, −1.26%]) for those aged <65 years and −13.66 mmol/mol (−1.25%) (95% CI −14.54, −12.79 [−1.33%, −1.17%]) for those aged ≥65 years. At EOT, achievement of HbA1c targets was similar between the group aged <65 years and the group aged ≥65 years: <53 mmol/mol (<7%) (59.0% and 56.5%, respectively), <59 mmol/mol (<7.5%) (75.5% and 73.0%, respectively) and <64 mmol/mol (<8%) (83.8% and 84.1%, respectively). The incidence and event rate of American Diabetes Association Level 1 hypoglycaemia during the studies were also comparable between the two groups: 26.7% and 28.2% and 1.7 and 2.1 events per patient‐year for the group aged <65 years and the group aged ≥65 years, respectively. A clinically relevant reduction in HbA1c (>1% from baseline for HbA1c ≥64 mmol/mol [≥8%] or ≥0.5% from baseline for HbA1c <64 mmol/mol [<8%]) without hypoglycaemia was attained by 50.0% and 47.6% of participants aged <65 years and ≥65 years, respectively. Adverse events were similar between the two age groups.ConclusionsiGlarLixi is a simple, well‐tolerated, once‐daily alternative for treatment advancement in older people with T2D that provides significant improvements in glycaemic control without increasing hypoglycaemia risk, thus reducing the treatment burden.

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Expert Panel Guidance and Narrative Review of Treatment Simplification of Complex Insulin Regimens to Improve Outcomes in Type 2 Diabetes

Cited by 26 publications

References 78 publications

A population-based analysis of insulin management patterns in a province of southern Spain (2014-2018)

A population-based analysis of insulin management patterns in a province of southern Spain (2014-2018)

Effectiveness, Safety, and Appropriateness in the Use of the Fixed-Ratio Combination of Insulin Glargine and Lixisenatide in Type 2 Diabetes: The ENSURE Retrospective Real-World Study

Advancing type 2 diabetes therapy with iGlarLixi in older people: Pooled analysis of four randomized controlled trials

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