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Clinical considerations when initiating and titrating insulin Degludec/Liraglutide (IDegLira) in people with type 2 diabetes

Clinical considerations when initiating and titrating insulin Degludec/Liraglutide (IDegLira) in people with type 2 diabetes
Clinical considerations when initiating and titrating insulin Degludec/Liraglutide (IDegLira) in people with type 2 diabetes
Therapeutic inertia is a substantial obstacle to the initiation of insulin therapy in people with uncontrolled type 2 diabetes (T2D). This effect has in part been perpetuated by concerns over the impact of a burdensome regimen and the increased risk of hypoglycemia and body weight gain often associated with insulin use. An effective, yet simple, less burdensome regimen with a lower risk of body weight gain and hypoglycemia compared with an insulin-only regimen, may help to address these concerns more effectively. We review the available clinical and real-world data on IDegLira, a once-daily, injectable, fixed-ratio combination of insulin degludec (degludec) and the glucagon-like peptide-1 receptor agonist (GLP-1RA) liraglutide, in people with T2D. Evidence from the comprehensive DUAL clinical trial program suggests an advantage of IDegLira over traditional insulin therapies in a number of clinical outcomes, including maintenance of glycemic control, achievement of glycemic targets, reducing the risk of hypoglycemia, and body weight loss. These findings were demonstrated in participants with T2D irrespective of prior GLP-1RA and insulin use. Furthermore, the individual components of IDegLira have confirmed safety (degludec) or significant benefit in terms of improvement of cardiovascular risk (liraglutide). As an injectable therapy that is simple to titrate, IDegLira has the potential to optimize the ability to achieve relevant glycemic targets, and offers a suitable treatment option for people with T2D requiring insulin therapy who are at risk of hypoglycemia or weight gain.
0012-6667
147–165
Harris, Stewart
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Abrahamson, Martin
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Ceriello, Antonio
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Charpentier, Guillaume
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Evans, Marc
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Lehmann, Roger
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Liebl, Andreas
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Linjawi, Sultan
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Holt, Richard
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Hosszúfalusi, Nóra
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Rutten, Guy
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Vilsbøll, Tina
f95c5a1d-95a5-4e7a-b1af-2834355f130c
Harris, Stewart
434e4659-95c6-4890-9581-efa848ce53c8
Abrahamson, Martin
2622ba11-ffa6-49b1-8d5f-4f113bedd7b3
Ceriello, Antonio
bc758779-acf0-4634-b729-f2f302b7c2ef
Charpentier, Guillaume
9b5c1689-84e3-40e9-ae8c-ad6794d6bfbe
Evans, Marc
69d4cb95-ee79-4b8c-a272-f98f20141956
Lehmann, Roger
38068556-b322-4a3f-808b-8d0183724c57
Liebl, Andreas
af02bc10-b2da-4371-b475-d5162fb5d9bb
Linjawi, Sultan
317e1242-c33f-44ed-aeff-924bc375558d
Holt, Richard
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Hosszúfalusi, Nóra
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Rutten, Guy
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Vilsbøll, Tina
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Harris, Stewart, Abrahamson, Martin, Ceriello, Antonio, Charpentier, Guillaume, Evans, Marc, Lehmann, Roger, Liebl, Andreas, Linjawi, Sultan, Holt, Richard, Hosszúfalusi, Nóra, Rutten, Guy and Vilsbøll, Tina (2020) Clinical considerations when initiating and titrating insulin Degludec/Liraglutide (IDegLira) in people with type 2 diabetes. Drugs, 80 (2), 147–165. (doi:10.1007/s40265-019-01245-3).

Record type: Article

Abstract

Therapeutic inertia is a substantial obstacle to the initiation of insulin therapy in people with uncontrolled type 2 diabetes (T2D). This effect has in part been perpetuated by concerns over the impact of a burdensome regimen and the increased risk of hypoglycemia and body weight gain often associated with insulin use. An effective, yet simple, less burdensome regimen with a lower risk of body weight gain and hypoglycemia compared with an insulin-only regimen, may help to address these concerns more effectively. We review the available clinical and real-world data on IDegLira, a once-daily, injectable, fixed-ratio combination of insulin degludec (degludec) and the glucagon-like peptide-1 receptor agonist (GLP-1RA) liraglutide, in people with T2D. Evidence from the comprehensive DUAL clinical trial program suggests an advantage of IDegLira over traditional insulin therapies in a number of clinical outcomes, including maintenance of glycemic control, achievement of glycemic targets, reducing the risk of hypoglycemia, and body weight loss. These findings were demonstrated in participants with T2D irrespective of prior GLP-1RA and insulin use. Furthermore, the individual components of IDegLira have confirmed safety (degludec) or significant benefit in terms of improvement of cardiovascular risk (liraglutide). As an injectable therapy that is simple to titrate, IDegLira has the potential to optimize the ability to achieve relevant glycemic targets, and offers a suitable treatment option for people with T2D requiring insulin therapy who are at risk of hypoglycemia or weight gain.

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Clinical_use_of_IDegLira_review_resubmitted - Accepted Manuscript
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Accepted/In Press date: 17 November 2019
e-pub ahead of print date: 20 January 2020

Identifiers

Local EPrints ID: 436011
URI: http://eprints.soton.ac.uk/id/eprint/436011
ISSN: 0012-6667
PURE UUID: 592eda94-bd32-4198-b44e-0027c7d9486b
ORCID for Richard Holt: ORCID iD orcid.org/0000-0001-8911-6744

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Date deposited: 26 Nov 2019 17:30
Last modified: 28 Apr 2022 01:48

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Contributors

Author: Stewart Harris
Author: Martin Abrahamson
Author: Antonio Ceriello
Author: Guillaume Charpentier
Author: Marc Evans
Author: Roger Lehmann
Author: Andreas Liebl
Author: Sultan Linjawi
Author: Richard Holt ORCID iD
Author: Nóra Hosszúfalusi
Author: Guy Rutten
Author: Tina Vilsbøll

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