Real-world treatment-transition pathways and dosing patterns of insulin degludec/liraglutide in Chinese adults with type 2 diabetes.
In a real-world setting, mean HbA1c decreased by 1.66 percentage points after 12 weeks of treatment with insulin degludec/liraglutide in adults with type 2 diabetes.
Where it sits
this study against the rest of the liraglutide corpusSummary and findings
This study examined treatment-transition pathways and dosing patterns of insulin degludec/liraglutide in 1499 Chinese adults with type 2 diabetes. The mean HbA1c decreased by 1.66 percentage points from baseline to week 12. Body weight also decreased by an average of 2.76 kg over the same period.
Abstract
<h4>Background and aims</h4>To describe real-world treatment-transition pathways, early IDegLira dosing patterns, treatment simplification, and observed short-term clinical outcomes among Chinese adults with type 2 diabetes (T2D).<h4>Methods</h4>This multicenter, non-interventional, retrospective observational registry included 1499 adults with T2D who initiated IDegLira in routine practice across 13 provinces and regions in China from April 2022 to December 2023. The five mutually exclusive prior-treatment pathways were non-injectable therapy, basal insulin, multiple daily injections (MDI), insulin plus GLP-1RA, and GLP-1RA-based therapy. Treatment decisions were physician-directed. Eligible patients had documented continuous use of once-daily IDegLira (the fixed-ratio combination [FRC]) for at least 3 months. Early dosing was defined as the starting dose, dose titration, and dose documented at approximately 12 weeks. Exploratory linear models estimated crude and covariate-adjusted between-pathway differences in paired HbA1c and body-weight change.<h4>Results</h4>Baseline HbA1c was available for 1374 patients (9.05 ± 1.78%) and week-12 HbA1c for 498 patients (7.44 ± 2.29%). Among 480 patients with paired baseline and week-12 HbA1c data (all enrolled in the final study period), mean HbA1c decreased from 9.11 ± 2.09% to 7.45 ± 2.28% (mean change -1.66 ± 2.23 percentage points; P < 0.001). Among the week-12 evaluable population, 21.08%, 47.39%, 81.73%, and 89.36% had HbA1c ≤ 6.5%, <7.0%, <7.5%, and <8.0%, respectively. Among 487 patients with paired baseline and week-12 body-weight data (all from the final study period), mean body weight decreased from 75.48 ± 11.12 to 72.72 ± 10.56 kg (mean change -2.76 ± 4.93 kg). In exploratory adjusted models, HbA1c reductions were smaller after basal insulin (mean difference +0.82 percentage points, 95% CI 0.37 to 1.27) and MDI (+1.25, 95% CI 0.53 to 1.98) than after non-injectable therapy, whereas no overall adjusted pathway association was observed for body-weight change (global P = 0.606). The mean starting dose was 14.46 ± 4.06 U and the mean week-12/current dose was 16.72 ± 4.55 U among available cases. Prandial insulin discontinuation was recorded in 269/301 MDI patients (89.37%); concurrent paired HbA1c and systematic post-initiation safety data were unavailable for this subgroup.<h4>Conclusions</h4>This study describes real-world treatment-transition and dosing patterns for IDegLira across heterogeneous prior therapies. Glycemic findings are based on the week-12 evaluable population (498 of 1499 patients, all enrolled in the final study period); among 480 patients with paired baseline and week-12 HbA1c data, mean HbA1c decreased by 1.66 percentage points. The study had no comparator group and no basis for causal inference. The findings are descriptive and hypothesis-generating, and may inform clinical discussions and future comparative studies.
Background
This paper addresses treatment-transition pathways and dosing patterns of insulin degludec/liraglutide in adults with type 2 diabetes. Prior studies have primarily focused on clinical trials rather than real-world settings. Understanding these pathways is essential for optimizing diabetes management in diverse populations.
Methods
This multicenter, non-interventional, retrospective observational registry included 1499 adults with type 2 diabetes who initiated IDegLira from April 2022 to December 2023. Patients were required to have documented continuous use of IDegLira for at least 3 months. The study evaluated early dosing patterns and short-term clinical outcomes, focusing on HbA1c and body weight changes.
Results
Among 480 patients with paired baseline and week-12 HbA1c data, mean HbA1c decreased by 1.66 ± 2.23 percentage points (P < 0.001). The study reported a mean body weight reduction of 2.76 ± 4.93 kg. Adjusted models indicated smaller HbA1c reductions after basal insulin and multiple daily injections compared to non-injectable therapy.
Interpretation
The findings suggest a significant reduction in HbA1c after transitioning to IDegLira, although the clinical significance of a 1.66 percentage point reduction may vary among practitioners. The lack of a comparator group and the observational nature of the study limit the ability to draw causal conclusions. These results may inform future studies but should be interpreted with caution.
Key findings
- Mean HbA1c decreased from 9.11 ± 2.09% to 7.45 ± 2.28%, mean change -1.66 ± 2.23 percentage points; P < 0.001.
- 21.08%, 47.39%, 81.73%, and 89.36% had HbA1c ≤ 6.5%, <7.0%, <7.5%, and <8.0%, respectively.
- Mean body weight decreased from 75.48 ± 11.12 to 72.72 ± 10.56 kg, mean change -2.76 ± 4.93 kg.
- Mean starting dose was 14.46 ± 4.06 U and mean week-12/current dose was 16.72 ± 4.55 U.
- Prandial insulin discontinuation was recorded in 269/301 MDI patients (89.37%).
Limitations
- No comparator group.
- Descriptive study design limits causal inference.
- Observational nature may introduce confounding factors.
- Short follow-up duration of 12 weeks.
- Single-site data collection across 13 provinces.