Minimizing Hypoglycemia and Weight Gain with Intensive Glucose Control: Potential Benefits of a New Combination Therapy (IDegLira)

Abstract

Due to the progressive nature of type 2 diabetes (T2D), the majority of patients require increasing levels of therapy to achieve and maintain good glycemic control. At present, once patients become uncontrolled on oral antidiabetic therapies, the two primary treatment options are glucagon-like peptide-1 receptor agonists (GLP-1RAs) or basal insulin, although earlier use of GLP-1RAs has also been advocated. While both of these drug classes have proven efficacy in treating T2D, there can be limitations to their use in some patients, and resistance to further treatment intensification among both patients and physicians. More recently, treatment incorporating both a GLP-1RA and a basal insulin has been used successfully in the clinic and the first such combination product, IDegLira (insulin degludec + liraglutide), has recently been approved for use in Europe. IDegLira combines insulin degludec and the GLP-1RA liraglutide in a single injection. In both insulin-naïve and basal insulin-treated individuals with T2D, IDegLira has demonstrated greater reductions in glycated hemoglobin (HbA1c) than either of the individual components, with a low rate of hypoglycemia and weight loss. IDegLira may provide a new option for patients requiring treatment intensification but for whom increased weight or a higher risk of hypoglycemia are barriers. This article discusses the rationale behind combining these two drug classes and reviews the available clinical evidence for the efficacy and safety of IDegLira.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-015-0208-2) contains supplementary material, which is available to authorized users.

Insulin treatment and longer diabetes duration both predict poorer glycaemic response to liraglutide treatment in type 2 diabetes: the Association of British Clinical Diabetologists Nationwide Liraglutide Audit

“…Recent clinical studies have shown that combinations of GLP-1 agonists and insulin are a rational treatment choice, as the inclusion of the GLP-1 agonist improves antihyperglycaemic efficacy while limiting the weight gain and hypoglycaemia associated with insulin. 17,18 Hence, the efficacy of liraglutide should both be judged across patients with different stages of diabetes, as well as judged at the level of the individual patient against other available therapeutic options at their stage of disease.…”

Treating Patients with Type 2 Diabetes Mellitus Uncontrolled on Basal Insulin in the Czech Republic: Cost-Effectiveness of IDegLira Versus iGlarLixi

“…In 2017, it was estimated that 863,106 people in the Czech Republic were living with diagnosed diabetes (patients with impaired glucose tolerance not included), of whom 84% had type 2 diabetes mellitus (T2DM) [2]. Good glycemic control is crucial to reduce the incidence of diabetes-related complications and, consequently, the clinical and economic burden associated with diabetes [3, 4]. In the Czech Republic, lifestyle changes and metformin therapy are recommended as first-line therapy for patients with T2DM [5].…”

Insulin degludec/liraglutide versus its monotherapy on T2D patients: A lifetime cost-utility analysis in China

“…New therapies with improved safety and convenience are needed to address this problem. Some progress has been made to address this problem, such as the development and use of IDegLira (Morales and Merker, 2015).…”