Is IDegLira more effective than degludec or liraglutide alone for treating uncontrolled Type 2 diabetes?

This study compared IDegLira (Xultophy) to insulin degludec (Tresiba) or liraglutide (Victoza) alone in patients with uncontrolled Type 2 diabetes (T2D). The authors concluded that combined IDegLira was more effective and had fewer side effects than either insulin medication alone.

One of the main goals of treatment for T2D is to reduce blood sugar levels. Because T2D is a progressive condition, insulin doses need to be adjusted to make sure it continues to work. However, increasing doses of insulin therapy can cause blood sugar levels to become too low. This is called hypoglycemia (HG). IDegLira may help reduce the risk of HG while keeping blood sugar levels under control.

IDegLira combines two anti-diabetes medications in a once-daily injection. Insulin degludec (IDeg) is a long-acting insulin. Liraglutide (Lira) is a long-acting GLP-1 receptor agonist. This drug helps the pancreas release insulin when blood sugar levels are too high. It can also help promote weight loss. Whether IDegLira is safe and effective for patients with uncontrolled T2D is unclear.

This study had 819 patients with uncontrolled T2D already taking non-insulin medication. Patients were divided into three groups. Patients received IDegLira (275 patients), IDeg (271 patients) or Lira (273 patients). Patients were treated for 52 weeks. 

HbA1c (average blood glucose over 3 months) decreased the most in the IDegLira group (26.5 mmol/mol). For the other two groups, HbA1c decreased by 19.6 mmol/mol (IDeg) and 19.7 mmol/mol (Lira).

Overall, IDegLira decreased HbA1c by 6.91 mmol/mol compared to IDeg alone and 5.30 mmol/mol compared to Lira alone. IDegLira also significantly increased the odds of reaching an HbA1c level below 7% compared to IDeg (4.7-fold higher odds) and Lira (4.76-fold higher odds) alone.

At the end of treatment, IDegLira significantly lowered body weight (by 1.19 kg) and the risk of HG (by 52%) compared to IDeg alone. However, IDegLira increased body weight (3.89 kg) and the risk of HG (37.58-fold) compared to Lira alone.

Overall, 83.3% (IDegLira), 79.7% (IDeg), and 83.9% (Lira) of patients had side effects. Most were mild. Chest infections were the most common, followed by constipation, diarrhea, and nausea.

This study found that IDegLira significantly improved blood sugar levels and lowered the risk of HG compared to insulin alone for patients with uncontrolled T2D.

This study received funding from Novo Nordisk, the manufacturer of IDegLira. This study was also done in Japan with Japanese patients only, so these results may not apply to all patients. Also, only patients with uncontrolled T2D were included. More studies are needed to confirm these results.