Use and effectiveness of a fixed‐ratio combination of insulin degludec/liraglutide (IDegLira) in a real‐world population with type 2 diabetes: Results from a European, multicentre, retrospective chart review study

Abstract

AimsTo describe the real‐world use and effectiveness of IDegLira, a fixed‐ratio combination of the basal insulin degludec, and the glucagon‐like peptide‐1 receptor agonist (GLP‐1RA) liraglutide.Materials and MethodsThis European, multicentre, retrospective chart review comprised adults (n = 611) with type 2 diabetes, who started IDegLira ≥6 months before data collection. Clinical characteristics were assessed at baseline (defined as the most recent recording during the 6 months before the first IDegLira prescription) and 3, 6, 9 and 12 months (± 45 days for each time point) after commencing IDegLira, where data were available.ResultsBaseline regimens included non‐injectable medications (19%), basal insulin (19%), GLP‐1RA (10%), free combination therapy (insulin/GLP‐1RA, 24%) and multiple daily‐dose insulin injections (MDI, 28%), all ± oral antidiabetic drugs. After 6 months, significant glycated haemoglobin (HbA1c) reductions were observed in patients overall and in all subgroups (−10 mmol/mol [−0.9%] overall; P < .0001), and a significant reduction in mean body weight (−0.7 kg; P < .05) was observed in patients overall and in patients receiving MDI (−2.4 kg; P < .0001). The mean IDegLira dose was 22, 30 and 32 dose steps at initiation, and at 6 and 12 months follow‐up, respectively. In total, only 67 patients reached the maximum 50 dose steps, with most coming from the free combination therapy (n = 31) or MDI (n = 15) baseline regimen groups. Hypoglycaemia rates were reduced by 82% (rate ratio 0.18; P < .0001) in the 6‐month period after vs before IDegLira initiation. Overall, a total of 12 patients experienced 15 events in the 6 months after IDegLira initiation.ConclusionIn real‐world practice, after 6 months and at a moderate dose, IDegLira resulted in substantial reductions in HbA1c and body weight, with a reduced risk of hypoglycaemia.

Free and fixed‐ratio combinations of basal insulin and GLP‐1 receptor agonists versus basal insulin intensification in type 2 diabetes: A systematic review and meta‐analysis of randomized controlled trials

“…Previous meta‐analyses of randomized controlled trials (RCTs) have shown a mean reduction of HbA1c of around 0.45% in favour of the insulin/GLP‐1RA combination (combo) as compared with other injectable treatment strategies, with no increased hypoglycaemia and reduced body weight. In addition, the results coming from the expanding real world use of the combo strategies tend to confirm the findings of RCTs …”

“…In another real world study of 39 599 patients with type 2 diabetes who added insulin to a previous GLP‐1RA treatment, the reduction of HbA1c was 0.55% (4 mmol/mol) at 24 months . Finally, in 611 adults with type 2 diabetes, IDegLira initiation produced, after 6 months, significant reductions of HbA1c (−0.9%) (7 mmol/mol) and mean body weight (−0.7 kg). Interestingly, IDegLira was used as an intensification strategy for patients receiving a broad variety of treatment regimens.…”

Metabolic Control and Adherence to Therapy in Type 2 Diabetes Mellitus Patients Using IDegLira in a Real-World Setting

“…They are also supported by the findings of several previous studies that have examined the effect of the IDegLira FRC in real-world setting. In all of these studies, a substantial and significant [16][17][18][19].…”

“…The largest of these studies is the European multicenter retrospective real-world EXTRA study, which included 611 patients from five countries on different baseline treatment regimens [16]. In the EXTRA study, IDegLira use resulted in improved glycemic control across all baseline therapy groups, with a substantial -0.9% overall reduction in HbA 1c (P \ 0.001) after 6 months from the initiation of therapy.…”

Insulin degludec/liraglutide (IDegLira) maintains glycaemic control and improves clinical outcomes, regardless of pre‐trial insulin dose, in people with type 2 diabetes that is uncontrolled on basal insulin

“…Specifically, with the highest pre‐trial dose (40–50 units), the average dose of IDegLira was ~ 40 units by week 12 and plateaued thereafter. This is in contrast to the end‐of‐study IDegLira dose reported from the EXTRA study, a European, multicentre, retrospective chart review of 611 participants with type 2 diabetes, in which participants had a mean IDegLira dose of 30.2 units at 6 months and mean HbA 1c was 59 mmol/mol (7.5%), from a baseline value of 69 mmol/mol (8.5%) . These results suggest that real‐world outcomes could be further improved with greater focus on titration.…”