A Fixed Combination of Long-Acting Insulin and GLP-1 Receptor Agonist

Long-acting basal insulin can be given with a glucagon-like peptide-1 receptor agonist (GLP-1RA) for treating patients with type 2 diabetes. In this industry-sponsored, open-label trial, 557 diabetic adults who had been taking glargine plus metformin were randomized to once-daily injection of basal insulin (glargine) alone or once-daily injection of a fixed-ratio combination of basal insulin degludec plus the GLP-1RA liraglutide. Fixed-combination degludec/liraglutide is not yet FDA approved; the two components are available separately as Tresiba and Victoza, respectively.

At baseline, mean age was 59 years, mean diabetes duration was 11 years, and mean glycosylated hemoglobin (HbA_1c) was 8.3%. Both glargine and combination degludec/liraglutide were adjusted to achieve fasting blood glucose levels of 72 to 90 mg/dL. At 26 weeks, these statistically significant differences were noted:

• Mean HbA_1c had fallen by 1.8% with degludec/liraglutide and by 1.1% with glargine.

• Mean daily insulin dose was 41 units with degludec/liraglutide and 66 with glargine.

• Mean weight was 1.4 kg lower with degludec/liraglutide and 1.8 kg higher with glargine.

• Hypoglycemia was less common with degludec/liraglutide than with glargine (2.2 vs. 5.0 episodes per patient-year), although only one episode was serious.

• Nausea was more common in degludec/liraglutide patients than in glargine patients (9% vs. 1%).