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Effectiveness of insulin regimens for patients with uncontrolled type 2 diabetes

The JAMA Network Journals

In a study appearing in the March 1, 2016 issue of JAMA, John B. Buse, M.D., Ph.D., of the University of North Carolina School of Medicine, Chapel Hill, and colleagues compared the outcomes of once-daily injection of basal insulin (glargine) vs a once-daily injection of the combination of basal insulin degludec and the glucagon-like peptide-1 receptor agonist liraglutide in patients with uncontrolled type 2 diabetes.

Achieving optimal glucose control is a challenge for the majority of patients with type 2 diabetes, with less than one-third of patients treated with basal insulin reaching a glycated hemoglobin (HbA1c) level of less than 7 percent. In this trial, 557 patients with uncontrolled diabetes were randomly assigned to degludec/liraglutide (n = 278) or glargine (n = 279). The 26-week trial was conducted at 75 centers in 10 countries.

The researchers found that HbA1c level reduction was greater with degludec/liraglutide vs glargine, and met criteria for noninferiority (not worse than). Secondary analysis indicated a greater HbA1c level reduction with degludec/liraglutide. Analyses also indicated that degludec/liraglutide was associated with weight loss compared with weight gain with glargine, and a lower rate of hypoglycemia. Overall and serious adverse event rates were similar in the 2 groups, except for more nonserious gastrointestinal adverse events reported with degludec/liraglutide.

"Further research is indicated to evaluate the durability of the effects of degludec/liraglutide in longer-term studies, in clinical practice, and to assess whether patients and physicians consider degludec/liraglutide a suitable treatment option to overcome barriers to treatment intensification," the authors write.

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(doi:10.1001/jama.2016.1252; the study is available pre-embargo at the For The Media website.)

Editor's Note: This study was funded by Novo Nordisk. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.

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