Introduction: The current management of type 2 diabetes mellitus (T2D) requires a comprehensive approach to achieve goals, emphasizing treatment compliance through periodic surveillance.
Purpose: The purpose of this study was to determine the effectiveness of insulin degludec/liraglutide therapy (IDegLira) on glycemic control in adults with T2D in a real-world setting, with follow-up care provided via teleconsultation during the COVID-19 pandemic.
Materials and methods: Analysis of a real-world anonymized database of patients with T2D, treated in a specialized medical institution between March 2020 and March 2021. HbA1c levels and fasting blood glucose were evaluated at three and six months of follow-up.
Results: We included 61 patients between the age of 43 and 94 years. Most of the patients used oral antidiabetics (75.41%), 85.25% had insulin formulations (basal or basal-bolus), and half of the subjects (55.74%) had insulin-combined formulations. From an average level of HbA1c at baseline of 8.44% (SD 1.4), significant reductions were observed at three months (-0.48%, CI -0.10 to -0.86) and six months-(0.94%, CI -0.55 to -1.33), consistent with a decrease in fasting glycemia (-37.80 mg/dL, CI -21.62 to -53.97 at six months) and with an increase in the proportion of patients achieving glycemic goals. Insulin requirements (total daily dose) decreased on average 11.3 U (CI -6.59 to -16.01, p 0.00). No episodes of significant hypoglycemia were reported.
Conclusions: In the real world, IDegLira generated significant changes towards glycemic control in adults with T2D, with no reports of hypoglycemia for up to 6 months in the context of virtual medical care.
World Health Organization. Diabetes. Key facts. [Internet]. World Health Organization; 2021 [updated 2021 Sept 16; cited 2022 Oct15]. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes
Cannon A, Handelsman Y, Heile M, Shannon M. Burden of illness in type 2 diabetes mellitus. J Manag Care Spec Pharm. 2018;24(9-a Suppl):S5-13. https://doi.org/10.18553/jmcp.2018.24.9-a.s5
Davies MJ, D’Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2018;61(12):2461-98. https://doi.org/10.1007/s00125-018-4729-5
Krass I, Schieback P, Dhippayom T. Adherence to diabetes medication: a systematic review. Diabet Med. 2015;32(6):725-37. https://doi.org/10.1111/dme.12651
Iglay K, Cartier SE, Rosen VM, Zarotsky V, Rajpathak SN, Radican L, et al. Meta-analysis of studies examining medication adherence, persistence, and discontinuation of oral antihyperglycemic agents in type 2 diabetes. Curr Med Res Opin. 2015;31(7):1283-96. https://doi.org/10.1185/03007995.2015.1053048
Shaw SE, Cameron D, Wherton J, Seuren LM, Vijayaraghavan S, Bhattacharya S, et al. Technology-Enhanced consultations in diabetes, cancer, and heart failure: protocol for the qualitative analysis of remote consultations (QuARC) project. JMIR Res Protoc. 2018;7(7):e10913. https://doi.org/10.2196/10913
Rubin RR. Adherence to pharmacologic therapy in patients with type 2 diabetes mellitus. Am J Med. 2005;118(5):27-34. https://doi.org/10.1016/j.amjmed.2005.04.012
Lingvay I, Manghi FP, García-Hernández P, Norwood P, Lehmann L, Tarp-Johansen MJ, et al. Effect of insulin glargine up-titration vs insulin degludec/liraglutide on glycated hemoglobin levels in patients with uncontrolled type 2 diabetes: the DUAL V randomized clinical trial. Jama. 2016;315(9):898-907. https://doi.org/10.1001/jama.2016.1252
Gough S, Bode B, Woo V, Rodbard H, Linjawi S, Zacho M, et al. One?year efficacy and safety of a fixed combination of insulin degludec and liraglutide in patients with type 2 diabetes: results of a 26?week extension to a 26?week main trial. Diabetes Obes Metab. 2015;17(10):965-73. https://doi.org/10.1111/dom.12498
Gough SC, Bode B, Woo V, Rodbard HW, Linjawi S, Poulsen P, et al. Efficacy and safety of a fixed-ratio combination of insulin degludec and liraglutide (IDegLira) compared with its components given alone: results of a phase 3, open-label, randomised, 26-week, treat-to-target trial in insulin-naive patients with type 2 diabetes. Lancet Diabetes Endocrinol. 2014;2(11):885-93. https://doi.org/10.1016/S2213-8587(14)70174-3
Billings LK, Doshi A, Gouet D, Oviedo A, Rodbard HW, Tentolouris N, et al. Efficacy and safety of IDegLira versus basal-bolus insulin therapy in patients with type 2 diabetes uncontrolled on metformin and basal insulin: the DUAL VII randomized clinical trial. Diabetes Care. 2018;41(5):1009-16. https://doi.org/10.2337/dc17-1114
American Diabetes Association. 9. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes—2020. Diabetes Care. 2020;43(Supplement 1):S98-110. https://doi.org/10.2337/dc20-S009
Andreozzi F, Candido R, Corrao S, Fornengo R, Giancaterini A, Ponzani P, et al. Clinical inertia is the enemy of therapeutic success in the management of diabetes and its complications: a narrative literature review. Diabetol Metab Syndr. 2020;12(1):1-11. https://doi.org/10.1186/s13098-020-00559-7
Pantalone KM, Misra-Hebert AD, Hobbs TM, Ji X, Kong SX, Milinovich A, et al. Clinical inertia in type 2 diabetes management: evidence from a large, real-world data set. Diabetes Care. 2018;41(7):e113-4. https://doi.org/10.2337/dc18-0116
Pantalone KM, Wells BJ, Chagin KM, Ejzykowicz F, Yu C, Milinovich A, et al. Intensification of diabetes therapy and time until A1C goal attainment among patients with newly diagnosed type 2 diabetes who fail metformin monotherapy within a large integrated health system. Diabetes Care. 2016;39(9):1527-34. https://doi.org/10.2337/dc16-0227
Khunti K, Gomes MB, Pocock S, Shestakova MV, Pintat S, Fenici P, et al. Therapeutic inertia in the treatment of hyperglycaemia in patients with type 2 diabetes: a systematic review. Diabetes Obes Metab. 2018;20(2):427-37. https://doi.org/10.1111/dom.13088
Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375(4):311-22. https://doi.org/10.1056/NEJMoa1603827
Berlie H, Hurren KM, Pinelli NR. Glucagon-like peptide-1 receptor agonists as add-on therapy to basal insulin in patients with type 2 diabetes: a systematic review. Diabetes Metab Syndr Obes Targets Ther. 2012;5:165-174. https://doi.org/10.2147/DMSO.S27528
Lingvay I, Pérez Manghi F, García-Hernández P, Norwood P, Lehmann L, Tarp-Johansen MJ, et al. Effect of Insulin Glargine Up-titration vs Insulin Degludec/Liraglutide on Glycated Hemoglobin Levels in Patients with Uncontrolled Type 2 Diabetes: The DUAL V Randomized Clinical Trial. JAMA. 2016;315(9):898-907. https://doi.org/10.1001/jama.2016.1252
Billings LK, Doshi A, Gouet D, Oviedo A, Rodbard HW, Tentolouris N, et al. Efficacy and Safety of IDegLira Versus Basal-Bolus Insulin Therapy in Patients With Type 2 Diabetes Uncontrolled on Metformin and Basal Insulin: The DUAL VII Randomized Clinical Trial. Diabetes Care. 2018;41(5):1009-16. https://doi.org/10.2337/dc17-1114 b
Aroda VR, González-Galvez G, Grøn R, Halladin N, Haluzík M, Jermendy G, et al. Durability of insulin degludec plus liraglutide versus insulin glargine U100 as initial injectable therapy in type 2 diabetes (DUAL VIII): a multicentre, open-label, phase 3b, randomised controlled trial. Lancet Diabetes Endocrinol. 2019;7(8):596-605. https://doi.org/10.1016/S2213-8587(19)30184-6
Egede LE, Bogdanov A, Fischer L, Da Rocha Fernandes JD, Kallenbach L. Glycemic Control Among Patients Newly Prescribed IDegLira Across Prior Therapy Group in US Real-World Practice. Diabetes Ther. 2020;11(7):1579-89. https://doi.org/10.1007/s13300-020-00850-w
Zoltan T, Balázs B, Mónika K, András G, Varkonyi T. Simplifying Complex Insulin Regimens While Preserving Good Glycemic Control in Type 2 Diabetes. Diabetes Ther. 2019;10(5):1869-78. https://doi.org/10.1007/s13300-019-0673-8
Gangopadhyay KK, Majumdar S, Sinha B, Kovil R, Baruah MP. IRWIS (IDegLira Real world Indian Study): A Real-World Observational Study for Use of IDegLira In Indian Patients. Endocr Metab Sci. 2020;1(3-4):100057-100057. https://doi.org/10.1016/j.endmts.2020.100057
Hermione P, Blüher M, Prager R, Phan TM, Thorsted BL, Schultes B. Use and effectiveness of a fixed-ratio combination of insulin degludec/liraglutide (IDegLira) in a real-world population with type 2 diabetes: Results from a European, multicentre, retrospective chart review study. Diabetes Obes Metab. 2018;20(4):954-62. https://doi.org/10.1111/dom.13182
Marcolino M, Maia J, Alkmim M, Boersma E, Ribeiro A. Telemedicine application in the care of diabetes patients: Systematic review and meta-analysis. Diabetes Technol Ther. 2015;17:S55-6. https://doi.org/10.1371/journal.pone.0079246
Tchero H, Kangambega P, Briatte C, Brunet-Houdard S, Retali G-R, Rusch E. Clinical effectiveness of telemedicine in diabetes mellitus: a meta-analysis of 42 randomized controlled trials. Telemed E-Health. 2019;25(7):569-83. https://doi.org/10.1089/tmj.2018.0128
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2022 Revista Colombiana de Endocrinología, Diabetes & Metabolismo