Diabetes: add-on insulin degludec/liraglutide superior to insulin glargine

  • Philis-Tsimikas A & al.
  • Diabetes Obes Metab
  • 13 Feb 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • Add-on insulin degludec/liraglutide to sodium-glucose cotransporter-2 inhibitor was superior and non-inferior to insulin glargine in patients with uncontrolled type 2 diabetes mellitus (T2DM).

Why this matters

  • Previous cost-effectiveness analysis showed lower cost of treatment with insulin degludec/liraglutide per patient.

Study design

  • DUAL IX trial: 26-week, phase 3b, open-label, parallel-group, multinational, treat-to-target trial.
  • 210 insulin-naïve patients with uncontrolled T2DM were randomly assigned to add-on insulin degludec/liraglutide or insulin glargine to sodium-glucose cotransporter-2 inhibitor therapy.
  • Primary endpoint: change in HbA1c.
  • Funding: Novo Nordisk.

Key results

  • Insulin degludec/liraglutide was non-inferior to insulin glargine in terms of mean HbA1c reduction (1.9 vs 1.7% points; P<.0001 superiority was also confirmed in hba1c change points ci to>
  • Insulin degludec/liraglutide was also superior in terms for:
    • body weight (mean difference, −1.92 kg; 95% CI, −2.64 to −1.19);
    • severe or blood-glucose-confirmed symptomatic hypoglycaemia (rate ratio, 0.42; 95% CI, 0.23-0.75) and
    • total daily insulin dose (mean difference, −15.37 units; 95% CI, −19.60 to −11.13).
  • Treatment-emergent adverse event rate was 61.7% with insulin degludec/liraglutide and 58.6% with insulin glargine.
  • Insulin degludec/liraglutide treatment increased lipase levels and nausea incidence.


  • Open-label design.

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