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AimsTo compare the safety and efficacy of a simpler titration algorithm for insulin degludec/liraglutide (IDegLira) with that used in previous DUAL trials in insulin‐naïve patients with type 2 diabetes.Research design and methodsThis 32‐week, open‐label, non‐inferiority trial randomized adults with type 2 diabetes uncontrolled on metformin ± pioglitazone to receive IDegLira, titrated either once weekly, based on the mean of 2 pre‐breakfast plasma glucose (PG) readings (n = 210), or twice weekly, based on the mean of 3 pre‐breakfast PG readings (n = 210).ResultsMean HbA1c decreased from 8.2% (65 mmol/mol) to 6.1% (43 mmol/mol) with once‐weekly titration and from 8.1% (65 mmol/mol) to 6.0% (42 mmol/mol) with twice‐weekly titration; non‐inferiority was confirmed (estimated treatment difference: 0.12% [−0.04; 0.28]95% CI, 1.30 mmol/mol [−0.41; 3.01]95% CI). Approximately 90% of patients achieved HbA1c < 7% in each arm. Mean fasting PG was similar after 32 weeks. Weight change was −1.0 kg vs −2.0 kg for once‐weekly vs twice‐weekly titration. Rates of severe or blood glucose‐confirmed symptomatic hypoglycaemia were low in both arms: 0.16 events/patient‐year of exposure (PYE) for once‐weekly, 0.76 events/PYE for twice‐weekly titration. Mean IDegLira dose at 32 weeks was 41 dose steps (41 U IDeg/1.48 mg Lira) for both arms. Overall adverse event rates were 207.8 and 241.3 events/100 PYE with once‐weekly and twice‐weekly titration, respectively.ConclusionA pragmatic titration algorithm with once‐weekly adjustments based on 2 PG readings resulted in a safety and glycaemic efficacy profile similar to that with twice‐weekly adjustments based on 3 preceding PG values in insulin‐naïve patients.

In Brief Most patients with type 2 diabetes receive their medical care from primary care providers. Shared medical appointments (SMAs) are one option to meet the various medical and education needs of patients in one appointment, while also providing peer support and motivation. Research suggests that SMAs can be effective in improving knowledge, quality of life, and problem-solving skills in patients with diabetes. However, more research is needed to determine the optimal group size, format, and curriculum.

AimsExenatide is a glucagon-like peptide-1 receptor agonist shown to improve glycaemic control in patients with type 2 diabetes (T2DM). Intermittent exenatide exposure is achieved with the twice-daily formulation (ExBID), while the once-weekly formulation (ExQW) provides continuous exenatide exposure. This integrated, retrospective analysis compared safety and tolerability of ExQW vs. ExBID in patients with T2DM.MethodsData were pooled from two open-label, randomized, comparator-controlled, trials directly comparing ExQW (N = 277) to ExBID (N = 268). Between-group differences in adverse event (AE) and hypoglycaemia incidences were calculated. Incidence over time and duration of selected AEs (nausea, vomiting, and injection-site-related AEs) were also summarized.ResultsThe most common AEs were nausea, diarrhoea, injection-site pruritus, and vomiting. Nausea and vomiting occurred less frequently with ExQW vs. ExBID, peaking at initiation (ExQW) or at initiation and dose escalation (ExBID), and decreasing over time. Few patients discontinued because of gastrointestinal-related AEs. Injection-site AEs were more common with ExQW but decreased over time in both groups. No major hypoglycaemia occurred; minor hypoglycaemia occurred with low incidence in patients not using concomitant sulphonylurea, with no difference between ExQW and ExBID. Serious AEs and discontinuations because of AEs were reported with similar frequency in both groups.ConclusionsBoth exenatide formulations were generally safe and well-tolerated, with ExQW associated with less nausea and vomiting but more injection-site AEs. Continuous vs. intermittent exposure did not impact the overall tolerability profile of exenatide, with no evidence of prolonged duration or worsened intensities of AEs with continuous exposure.

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