The following is the transcript from an onsite interview with Dr. Neil Skolnik and Dr. Vanita Aroda at the 79th American Diabetes Association Scientific Sessions held June 7-11, 2019 in San Francisco, California. The transcript has been edited for clarity.
Neil Skolnik, MD: I’m Dr. Neil Skolnik, and here we are at the 79th American Diabetes Association Scientific Sessions. We have the privilege of talking to Dr. Vanita Aroda, who is the Director of Diabetes Research at Brigham and Women’s Hospital. Welcome, Vanita. Can you talk to us about the study that you presented earlier today?
Vanita R. Aroda, MD: This morning I presented the DUAL VIII clinical trial, which is a durability study comparing insulin degludec plus liraglutide (IDegLira) to insulin glargine (IGlar U100) in patients with type 2 diabetes inadequately controlled on oral antidiabetic agents.
The primary outcome of this trial was unique. It was the length of time until the need for treatment intensification. In other words, how long after we start patients on therapies do we need to think about adding another therapy? This was a 2-year, 104-week study, and the primary results showed that those who were initiated on IDegLira had about half the likelihood of meeting the criteria for treatment intensification compared to those initiated on basal insulin glargine alone.
Skolnik: That’s an important outcome because so often we face the question of “what do we do next?” in our patients who are not well controlled. Fortunately, we have options now. We can start someone on a long-acting insulin. We can start them on a GLP-1 receptor agonist. Or, we can start them on combination therapy. I think that in primary care we most frequently go right to long-acting insulin. And the results have important implications. Can you go over what you see as the implications of this?
Aroda: So, as you and I have discussed before, one of the big drivers of therapeutic inertia is hesitancy to escalate therapy. But if we can get the therapies right, to truly target the underlying pathophysiology and keep people at goal longer, then we may be able to help address the overall issue of clinical inertia.
In addition, when we think about insulin therapy, we talk about weight gain and hypoglycemia. We did look at those endpoints in DUAL VIII, and we found that, compared to IGlar U100, those on IDegLira had about 15 units less of an insulin dose, 1.7 kg less weight gain, and about a 56% reduction in severe or symptomatic hypoglycemia.
Skolnik: I’m glad you mentioned those endpoints as well because, when I talk to patients, it’s not just about efficacy. People hate gaining weight on insulin alone, and this offsets that to a degree.
Thank you, Dr. Aroda, for sharing this information with us. I’m Neil Skolnik for Univadis at the 79th American Diabetes Association Scientific Sessions.
Neil Skolnik, MD is a Professor of Family and Community Medicine at Sidney Kimmel Medical College, Thomas Jefferson University, and Associate Director of the Family Medicine Residency Program at Abington-Jefferson Health.
Vanita R. Aroda, MD is the Director of Diabetes Clinical Research at Brigham and Women's Hospital.