Simplification of complex insulin regimens using canagliflozin or liraglutide in patients with well‐controlled type 2 diabetes: A 24‐week randomized controlled trial

Abstract

Aims/Introduction We investigated the potential use of canagliflozin, in comparison with liraglutide, as an alternative to bolus insulin in patients with well‐controlled type 2 diabetes mellitus receiving multiple daily insulin injection therapy. Materials and Methods In 40 patients, with glycated hemoglobin (HbA1c) levels <7.5% controlled by multiple daily insulin injection therapy, all bolus insulin was randomly switched to canagliflozin (100 mg/day) or liraglutide (0.3–0.9 mg/day) for 24 weeks. Basal insulin was continued with dose adjustment according to a predefined algorithm. The end‐points were the change in the HbA1c level, glycemic variability assessed by continuous glucose monitoring, body mass index, insulin dose, quality of life (QOL) and safety assessments. Factors influencing the changes in QOL were also assessed using a simple regression analysis. Results The change in HbA1c from baseline was comparable between the treatments. Both treatments maintained the HbA1c level to the baseline levels with stable glucose variability and no severe hypoglycemia for 24 weeks, decreased total insulin dose, and significantly increased the QOL score. The change in QOL was significantly associated with injection frequency. Conclusions For patients with well‐controlled type 2 diabetes mellitus, under the support of basal insulin, complex insulin regimens can be simplified by replacing all bolus insulin with once‐daily canagliflozin or liraglutide, which improves patients’ QOL.

Conversations and Reactions Around Severe Hypoglycemia (CRASH): Japan Results From a Global Survey of People with T1DM or Insulin-Treated T2DM and Caregivers

“…The number of Japanese participants was limited, and the findings in this population may not represent the entire diabetes population. Although the number of participants was limited, similarly low numbers of SH among Japanese PWD are reported in other studies [3,[15][16][17]. As the majority of study participants had T1DM, caution should be employed when generalizing these findings to people with T2DM.…”

“…Abiru et al [17] reported SH events among 528 participants aged at least 26 years from the Study of Adults' Glycemia in T1DM; in this T1DM population, only 5.5% reported experiencing one or more SH events within the previous 6 months. As reported in the literature [3,[15][16][17], Japan has low rates of SH in people with T2DM and T1DM. Furthermore, in the current study, there were limited numbers of people who met the inclusion criteria for enrollment.…”

“…As shown in Table 1, 25 out of 44 participants with T1DM (71%), and 4 out of 9 Japanese participants with insulin-treated T2DM (44%), reported at least one SH event in the past 12 months. Regarding adults with insulin-treated T2DM, Ando et al [15] reported…”

Fixed-ratio combinations of basal insulin and glucagon-like peptide-1 receptor agonists as a promising strategy for treating diabetes

“…In addition, basal insulin therapy has been shown to cause less body weight gain than other insulin regimens[ 9 , 10 ]. The most practical protocol for a patient is a simple one of once daily injections, with easy dose adjustment, which is associated with a good QOL and appropriate fasting glucose concentrations[ 11 , 12 ]. However, although basal insulin is useful for managing fasting blood glucose concentrations, basal insulin does not always prevent postprandial hyperglycemia[ 13 ].…”

Updates of incretin‐related drugs for the treatment of type 2 diabetes

“…GLP‐1RAs are an attractive alternative treatment for bolus insulin injections because of their lower risk of hypoglycemia and weight loss benefit, especially for obese patients with type 2 diabetes. A recent report showed that simplification from an intensive insulin injection regimen (basal + bolus insulin injection) to liraglutide maintained the HbA1c level with stable glucose variability in patients with well‐controlled type 2 diabetes receiving multiple daily insulin injection therapy 15 . Furthermore, the replacement of the therapy decreased the total insulin dose and quality of life score, which are significantly associated with injection frequency.…”