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      Insulin degludec/liraglutide (IDegLira) for the treatment of type 2 diabetes

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          Abstract

          The progressive nature of type 2 diabetes necessitates that treatment is intensified as the disease advances. Several studies have shown that basal insulin and glucagon-like peptide-1 receptor agonists (GLP-1RAs) can be used in combination to successfully improve glycemic control and this combination is increasingly being considered as an alternative to intensification with prandial insulin. Insulin degludec/liraglutide (IDegLira) is the first fixed-ratio combination of a basal insulin and a GLP-1RA in a single formulation. Here we consider the benefits and potential limitations of such a combination, focusing on the unique modes of action of insulin degludec and the once-daily GLP-1RA liraglutide. IDegLira offers an efficacious combination therapy (mean end-of-trial HbA 1c was 6.4–6.9% across the five completed Phase 3 trials), which was well-tolerated in clinical trials. The complementary modes of action resulted in a low rate of hypoglycemia and no weight gain in insulin-treated patients. As a once-daily injection with effects on both fasting and post prandial hyperglycemia, IDegLira has the potential to help many patients reach glycemic target (60–81% of patients achieved HbA 1c <7% in clinical trials).

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          Insulin adherence behaviours and barriers in the multinational Global Attitudes of Patients and Physicians in Insulin Therapy study

          M Peyrot, A. Barnett, L F Meneghini … (2012)
          Aims To examine patient and physician beliefs regarding insulin therapy and the degree to which patients adhere to their insulin regimens. Methods Internet survey of 1250 physicians (600 specialists, 650 primary care physicians) who treat patients with diabetes and telephone survey of 1530 insulin-treated patients (180 with Type 1 diabetes, 1350 with Type 2 diabetes) in China, France, Japan, Germany, Spain, Turkey, the UK or the USA. Results One third (33.2%) of patients reported insulin omission/non-adherence at least 1 day in the last month, with an average of 3.3 days. Three quarters (72.5%) of physicians report that their typical patient does not take their insulin as prescribed, with a mean of 4.3 days per month of basal insulin omission/non-adherence and 5.7 days per month of prandial insulin omission/non-adherence. Patients and providers indicated the same five most common reasons for insulin omission/non-adherence: too busy; travelling; skipped meals; stress/emotional problems; public embarrassment. Physicians reported low patient success at initiating insulin in a timely fashion and adjusting insulin doses. Most physicians report that many insulin-treated patients do not have adequate glucose control (87.6%) and that they would treat more aggressively if not for concern about hypoglycaemia (75.5%). Although a majority of patients (and physicians) regard insulin treatment as restrictive, more patients see insulin treatment as having positive than negative impacts on their lives. Conclusions Glucose control is inadequate among insulin-treated patients, in part attributable to insulin omission/non-adherence and lack of dose adjustment. There is a need for insulin regimens that are less restrictive and burdensome with lower risk of hypoglycaemia.
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            Pancreatic safety of incretin-based drugs--FDA and EMA assessment.

            Amy G Egan, Eberhard Blind, Kristina Dunder … (2014)
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              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.

              Stephen Gough, Bruce Bode, Vincent Woo … (2014)
              A fixed-ratio combination of the basal insulin analogue insulin degludec and the glucagon-like peptide-1 (GLP-1) analogue liraglutide has been developed as a once-daily injection for the treatment of type 2 diabetes. We aimed to compare combined insulin degludec-liraglutide (IDegLira) with its components given alone in insulin-naive patients.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Expert Rev Endocrinol Metab
                Journal ID (iso-abbrev): Expert Rev Endocrinol Metab
                Journal ID (archive): IERE
                Journal ID (publisher-id): iere20
                Title: Expert Review of Endocrinology & Metabolism
                Publisher: Taylor & Francis
                ISSN (Print): 1744-6651
                ISSN (Electronic): 1744-8417
                Publication date (Print): 2 January 2016
                Publication date (Electronic): 18 November 2015
                Volume: 11
                Issue: 1
                Pages: 7-19
                Affiliations
                [ a ]Oxford Centre for Diabetes Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, Churchill Hospital , Headington, Oxford, UK
                [ b ]Endocrinology, Aurora Advanced Healthcare , Milwaukee, WI, USA
                [ c ]Department of Endocrinology and Metabolism, University of Manitoba , Winnipeg, MB, Canada
                Author notes
                [* ]Author for correspondence: Tel.: +44 1865 857 560; Fax: +44 1865 857 213 Stephen.gough@ 123456OCDEM.ox.ac.uk
                Article
                Publisher ID: 1113129
                DOI: 10.1586/17446651.2016.1113129
                PMC ID: 4894076
                PubMed ID: 27335581
                SO-VID: 755a3964-3868-407b-9bec-248072c34b1a
                Copyright © © 2015 The Author(s). Published by Taylor & Francis.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.

                History
                Page count
                Figures: 3, Tables: 2, References: 68, Pages: 13
                Funding
                Funded by: Novo Nordisk 10.13039/501100004191
                Categories
                Subject: Article
                Subject: Theme: Diabetes - Drug Profiles

                Keywords: type 2 diabetes,glucagon-like peptide-1 receptor agonist,ideglira,insulin
                Data availability:
                Keywords: type 2 diabetes, glucagon-like peptide-1 receptor agonist, ideglira, insulin

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