Switching to iGlarLixi Versus Continuing Daily or Weekly GLP-1 RA in Type 2 Diabetes Inadequately Controlled by GLP-1 RA and Oral Antihyperglycemic Therapy: The LixiLan-G Randomized Clinical Trial.

MedStar author(s):
Citation: Diabetes Care. 42(11):2108-2116, 2019 11.PMID: 31530665Institution: MedStar Health Research InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Diabetes Mellitus, Type 2/dt [Drug Therapy] | *Glucagon-Like Peptide-1 Receptor/ag [Agonists] | *Hypoglycemic Agents/ad [Administration & Dosage] | *Insulin Glargine/ad [Administration & Dosage] | *Peptides/ad [Administration & Dosage] | Adult | Blood Glucose/de [Drug Effects] | Diabetes Mellitus, Type 2/bl [Blood] | Diabetes Mellitus, Type 2/co [Complications] | Drug Administration Schedule | Drug Combinations | Drug Substitution | Drug Therapy, Combination | Exenatide/ad [Administration & Dosage] | Female | Glucagon-Like Peptides/aa [Analogs & Derivatives] | Glucagon-Like Peptides/ad [Administration & Dosage] | Glycated Hemoglobin A/de [Drug Effects] | Humans | Hypoglycemia/dt [Drug Therapy] | Hypoglycemia/et [Etiology] | Immunoglobulin Fc Fragments/ad [Administration & Dosage] | Male | Metformin/ad [Administration & Dosage] | Middle Aged | Pioglitazone/ad [Administration & Dosage] | Recombinant Fusion Proteins/ad [Administration & Dosage] | Sodium-Glucose Transporter 2 Inhibitors/ad [Administration & Dosage] | Treatment OutcomeYear: 2019Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0149-5992
Name of journal: Diabetes careAbstract: CONCLUSIONS: Switching to iGlarLixi improves glucose control for patients with type 2 diabetes insufficiently controlled on a maximum tolerated dose of a GLP-1 RA plus oral antihyperglycemic agents. Copyright (c) 2019 by the American Diabetes Association.OBJECTIVE: Fixed-ratio combinations of basal insulin plus glucagon-like peptide 1 receptor agonist (GLP-1 RA) allow concomitant administration of two proven complementary injectable therapies for type 2 diabetes. This study investigated switching to a titratable fixed-ratio combination of insulin glargine plus lixisenatide (iGlarLixi) in patients with type 2 diabetes receiving daily or weekly GLP-1 RA therapy.RESEARCH DESIGN AND METHODS: LixiLan-G, a randomized, open-label, 26-week trial, comparing switching to iGlarLixi versus continuing prior GLP-1 RA in patients with type 2 diabetes and HbA1c 7-9% (53-75 mmol/mol) taking maximum tolerated doses of a GLP-1 RA daily (60% on liraglutide once daily or exenatide twice daily) or weekly (40% on dulaglutide, exenatide extended release, or albiglutide) with metformin with or without pioglitazone and with or without sodium-glucose cotransporter 2 inhibitors. Adherence to randomized treatment was closely monitored throughout the study.RESULTS: iGlarLixi (n = 257) reduced HbA1c more than continued GLP-1 RA therapy (n = 257) from a baseline 7.8% (62 mmol/mol) in both to 6.7% (50 mmol/mol) and 7.4% (57 mmol/mol), respectively, at 26 weeks (least squares mean difference -0.6%; P < 0.0001). More iGlarLixi patients achieved HbA1c <7% (53 mmol/mol) (62% vs. 26%; P < 0.0001) and the composite of HbA1c <7% without documented symptomatic hypoglycemia (<54 mg/dL). Nausea and vomiting rates as well as numbers of documented symptomatic hypoglycemia events per patient-year were generally low but greater with iGlarLixi versus continued GLP-1 RA therapy.All authors: Aroda VR, Blonde L, Del Prato S, Frias J, Henry R, Ji C, Niemoeller E, Rosenstock J, Shehadeh N, Souhami EOriginally published: Diabetes Care. 2019 Sep 17Fiscal year: FY2020Digital Object Identifier: ORCID: Date added to catalog: 2019-10-10
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 31530665 Available 31530665

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

CONCLUSIONS: Switching to iGlarLixi improves glucose control for patients with type 2 diabetes insufficiently controlled on a maximum tolerated dose of a GLP-1 RA plus oral antihyperglycemic agents. Copyright (c) 2019 by the American Diabetes Association.

OBJECTIVE: Fixed-ratio combinations of basal insulin plus glucagon-like peptide 1 receptor agonist (GLP-1 RA) allow concomitant administration of two proven complementary injectable therapies for type 2 diabetes. This study investigated switching to a titratable fixed-ratio combination of insulin glargine plus lixisenatide (iGlarLixi) in patients with type 2 diabetes receiving daily or weekly GLP-1 RA therapy.

RESEARCH DESIGN AND METHODS: LixiLan-G, a randomized, open-label, 26-week trial, comparing switching to iGlarLixi versus continuing prior GLP-1 RA in patients with type 2 diabetes and HbA1c 7-9% (53-75 mmol/mol) taking maximum tolerated doses of a GLP-1 RA daily (60% on liraglutide once daily or exenatide twice daily) or weekly (40% on dulaglutide, exenatide extended release, or albiglutide) with metformin with or without pioglitazone and with or without sodium-glucose cotransporter 2 inhibitors. Adherence to randomized treatment was closely monitored throughout the study.

RESULTS: iGlarLixi (n = 257) reduced HbA1c more than continued GLP-1 RA therapy (n = 257) from a baseline 7.8% (62 mmol/mol) in both to 6.7% (50 mmol/mol) and 7.4% (57 mmol/mol), respectively, at 26 weeks (least squares mean difference -0.6%; P < 0.0001). More iGlarLixi patients achieved HbA1c <7% (53 mmol/mol) (62% vs. 26%; P < 0.0001) and the composite of HbA1c <7% without documented symptomatic hypoglycemia (<54 mg/dL). Nausea and vomiting rates as well as numbers of documented symptomatic hypoglycemia events per patient-year were generally low but greater with iGlarLixi versus continued GLP-1 RA therapy.

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