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Type 2 diabetes treatment optimized by metformin supplementation
DeVries JH. Diabetes Care. 2012;doi:10.2337/dc11-1928.
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When metformin was supplemented with liraglutide and then insulin detemir, patients developed better glycemic control, experienced sustained weight loss and displayed low hypoglycemia rates, according to research from a large prospective study.
J. Hans DeVries, MD, PhD, of the department of internal medicine at Academic Medical Centre in Amsterdam, the Netherlands, and colleagues were part of the Liraglutide-Detemir Study Group that evaluated the addition of liraglutide (Victoza, Novo Nordisk) to metformin in patients with type 2 diabetes, followed by augmentation with insulin detemir (Levemir, Novo Nordisk).
From March 2009 to April 2010, DeVries and colleagues followed 988 patients aged 18 to 80 years with type 2 diabetes from North America and Europe who were seen in offices located in multiple hospital-based sites in various countries.
“For those not reaching glycemic targets, intensification with insulin detemir provided clinically relevant additional glycemic control, sustaining previous weight loss and the very low hypoglycemia risk,” the researchers said.
During a 12-week run-in in which liraglutide was added to metformin, 167 of 988 patients withdrew, and 821 completed, with 498 reaching HbA1c levels <7%. A total of 323 did not reach target HbA1c levels and were then eligible for randomization, according to the researchers.
When researchers added insulin detemir (100 units/mL) to metformin and liraglutide 6 mg/mL among the 162 randomly assigned patients, HbA1c levels were reduced compared with continued metformin and liraglutide. The estimated difference was –0.52 (95% CI, –0.68 to –0.36).
According to data, both groups experienced weight loss during 26 weeks (–0.16 kg with detemir and –0.95 kg without).
At 26 weeks, systolic blood pressure decreased from run-in start by 3.13 mm Hg in the control group, 1.65 mm Hg in the insulin detemir group and 3.33 mm Hg in the observational group. After 38 weeks, the 498 patients treated with metformin and liraglutide who achieved the target HbA1c level of <7% experienced an average decrease of 1.3%.
Disclosure: This study was funded by Novo Nordisk. See the full study for the researchers’ financial relationships relevant to this article.