Simplifying complex insulin regimens with preserving good glycemic control in type 2 diabetes

Z. Taybani1, B. Bótyik1, M Katkó2, A. Gyimesi1

1Békés County Central Hospital – Dr. Réthy Pál Member Hospital, 1. Department of Endocrinology, Békéscsaba, Hungary
2University of Debrecen – Faculty of Medicine, Department of Internal Medicine – Division of Endocrinology, Debrecen, Hungary

Background

Type 2 diabetic patients presenting with severe hyperglycemia are often put on multiple daily insulin injections (MDI). If glucose toxicity resolves, the regimen may potentially be simplified, but there are no guidelines regarding this and a lot of patients are left on MDI for years. 

Aim

We aimed to examine prospectively the safety and efficacy of switching from MDI to once daily IDegLira, a fixed-ratio combination of insulin degludec and liraglutide, in relatively well controlled subjects with type 2 diabetes using low total daily insulin dose (TDD).

Method

23 adults with type 2 diabetes (mean+SD: age 64+10 years, HbA1c 6.69+0.87 %, BMI 30.36+5.62 kg/m2 body weight 88.2+18.6 kg, TDD 37.4+8.9 units, duration of diabetes 9.6+5.4 years) treated with MDI + metformin were enrolled in our study.  Previous insulins were stopped and once daily ideglira was started. IDegLira was titrated every 3 days with 2 dose steps (each dose steps contains 1 unit of insulin degludec and 0.036 mg of liraglutide) by the patients to achieve a self-measured pre-breakfast plasma glucose contrentration of <6mmol/l. Metformin was continued and titrated up to the maximal tolerated dose.

Results

After 100.3 days of average follow-up HbA1c, BMI and body weight decreased significantly. Mean HbA1c changed by 0.36% to 6.33+0.66% (p=0.003), body weight changed by -1.71 kg to 86.4+18.3kg (p=0.018), and BMI changed to 29.75+5.37 kg/m2 (p=0.015). At the end of the follow-up mean dose of IDegLira was 20.78 dose steps and mean dose of metformin was 1654+650 mg.
IDegLira+metformin combination therapy was safe and generally well tolerated. Transient gastrointestinal adverse events (nausea) were reported by 3 patients (13%). During the weeks before baseline visit 9 patients (39%) had documented (self-measured plasma glucose<3.9mmol/L) or symptomatic hypoglycemia. During the follow-up neihter documented or symptomatic hyoglycemia nor serious adverse events occured.

Discussion 

In everyday clinical practice switching from low dose MDI to IDegLira in patients with well-controlled type 2 diabetes is safe, may induce weight loss and result in similar or better glycemic control. Simplifying complex treatment regimens may improve adherence and quality of life.

Simplifying complex insulin regimens with preserving good glycaemic control in type 2 diabetes