Chapel Hill, NC—For patients with type 2 diabetes, achieving optimal glucose control often is an elusive target. Even when treated with basal insulin, more than two-thirds fail to lower their glycated hemoglobin (HbA1c) level to less than 7%.

While the traditional response has been intensifying the insulin regimen, according to a study published recently in JAMA, that can increase the risk of hypoglycemia and weight gain. Recently, international guidelines have recommended combining other agents with basal insulins as an alternative, the article notes.

In light of that, University of North Carolina School of Medicine researchers and colleagues compared the outcomes of once-daily injection of basal insulin (glargine) versus a once-daily injection of the combination of basal insulin degludec and the glucagon-like peptide-1 receptor agonist liraglutide in patients with uncontrolled type 2 diabetes.

For the 26-week trial conducted at 75 medical centers in 10 countries, 557 patients with uncontrolled diabetes were randomly assigned to degludec/liraglutide or up-titration of glargine from September 2013 to November 2014. 

With baseline HbA1c at 8.4% for the degludec/liraglutide group and 8.2% for the glargine group, reduction was greater for the patients receiving the combination, a decline of 1.81%, than the glargine group, -1.13%.

Furthermore, treatment with degludec/liraglutide was associated with minor weight loss compared to slight weight gain with glargine, as well as with fewer confirmed hypoglycemic episodes.

Adverse events were similar in the two groups, except that the degludec/liraglutide group had more gastrointestinal issues, although those weren't serious.

“Among patients with uncontrolled type 2 diabetes taking glargine and metformin,” according to study authors, “treatment with degludec/liraglutide compared with up-titration of glargine resulted in non-inferior HbA1c levels, with secondary analyses indicating greater HbA1c level reduction after 26 weeks of treatment.”

The researchers add, “Further research is indicated to evaluate the durability of the effects of degludec/liraglutide in longer-term studies, in clinical practice, and to assess whether patients and physicians consider degludec/liraglutide a suitable treatment option to overcome barriers to treatment intensification.”

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