Initiation of the Fixed Combination IDegLira in Patients with Type 2 Diabetes on Prior Injectable Therapy: Insights from the EASY French Real-World Study

Introduction Combining basal insulin (BI) with glucagon-like peptide-1 receptor agonist (GLP-1RA) is recognized as a relevant option to optimize glucose control in type 2 diabetes (T2D). The EASY real-world study aimed to evaluate the modalities of initiation and the effectiveness of the insulin Degludec plus Liraglutide (IDegLira) fixed-ratio combination in the French health care system. Methods A retrospective analysis included all patients with T2D and prior injectable therapy (GLP1-RA and/or insulin) who started treatment with IDegLira from September 2016 to December 2017 in 11 French diabetes centers. Baseline characteristics, reasons for IDegLira initiation, and modes of implementation were collected from the medical records. Changes in HbA(1c) and body weight were determined in patients with available follow-up data (nearest 6-month visit). Results IDegLira was initiated in 629 patients previously treated with GLP-1RA alone (11.6%), insulin alone (31.5% including 16.5% with BI and 14.9% with multiple daily injections [MDI]) or a free combination of GLP-1RA and insulin (56.9% including 44.8% with BI and 12.1% with MDI), associated or not with oral agents. IDegLira starting dose (mean of 29 +/- 11 dose steps) most often exceeded the recommended dose, and was significantly correlated with prior BI but not GLP-1RA dosage. At initiation, mean age, body mass index (BMI) and HbA(1c) were 60.1 +/- 10.2 years, 33.4 +/- 6.2 kg/m(2) and 8.8 +/- 1.7%, respectively. In 461 patients with available follow-up (median 178 days), HbA(1c) decreased in all subgroups submitted to treatment intensification (- 1.7 +/- 1.8% [p < 0.0001], - 1.2 +/- 1.8% [p < 0.001] and - 0.8 +/- 1.8% [p = 0.0026] in patients with prior GLP-1RA, BI or MDI therapy, respectively) but also in those switching from BI and GLP-1RA free combination (- 0.2 +/- 0.9%, p = 0.0419). Significant body weight gain occurred in patients previously treated with GLP-1RA alone (+ 1.5 +/- 5.8 kg, p = 0.0572) or combined to BI (+ 1.0 +/- 3.1 kg, p < 0.0001) while those on BI (- 1.4 +/- 4.6 kg, p = 0.0139) or MDI (- 1.4 +/- 5.0 kg, p = 0.0484) experienced weight loss. Conclusions While providing new information on the use of IDegLira in the French healthcare system, these data confirm the effectiveness of this fixed-ratio combination in the management of T2D.