COMMENTARY

Anne Peters: The Year in Diabetes

Anne L. Peters, MD; Mark Harmel, MPH

Disclosures

December 10, 2013

In This Article

Combination Long-Acting Insulins and GLP-1 Receptor Agonists for Type 2 Diabetes

Use of long-acting insulin along with a glucagon-like peptide 1 (GLP-1) receptor agonist has received increasing attention. This is in part a consequence of the difficulty in successfully using prandial insulin in individuals with type 2 diabetes. A particularly successful study was the DUAL 1 trial in which IDegLira, a fixed-dose combination of the long-acting insulin degludec and liraglutide, was given to people with type 2 diabetes.

The mean baseline A1c level was 8.3%, with an average reduction in A1c of 1.9%. Side effects were almost nonexistent, as a result of the very slow up-titration of liraglutide. Furthermore, rates of hypoglycemia were lower than with insulin alone.

When John Buse, MD, PhD, from the University of North Carolina, Chapel Hill, presented the results of the IDegLira trial at the ADA meeting,[25] he reported that "in my mind this is a demonstration of a sort-of souped-up insulin -- I hate to say it, but 'insulin on steroids.'"

FDA approval is major barrier to use of this combination. Liraglutide is available in the United States and Europe, but insulin degludec was not approved by the FDA, which asked for large-scale cardiovascular studies before it can be approved in the United States. In Europe, Novo Nordisk filed for approval of IDegLira in May of this year.

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