Improved patient-reported outcomes with iGlarLixi versus premix BIAsp 30 in people with type 2 diabetes in the SoliMix trial.

AIM: To assess patient-reported outcomes (PROs) in the SoliMix trial, which compared the efficacy and safety of iGlarLixi versus BIAsp 30 in people with type 2 diabetes (T2D). MATERIALS AND METHODS: SoliMix (EudraCT: 2017-003370-13), a 26-week, open-label study, randomized (1:1) 887 adults with T2D and HbA1c ≥7.5%-≤10.0% (≥58-≤86 mmol/mol) on basal insulin plus oral antihyperglycaemic drugs (OADs) to once-daily iGlarLixi or twice-daily premix insulin, BIAsp 30. PROs were assessed using the Treatment-Related Impact Measure Diabetes (TRIM-D) and Global Treatment Effectiveness Evaluation (GTEE) questionnaires. RESULTS: Over 26 weeks, iGlarLixi showed greater improvement from baseline versus BIAsp 30 in total TRIM-D score (least squares mean difference [95% confidence interval]: 5.08 [3.69, 6.47]; effect size: 0.32) and in each TRIM-D domain, with the greatest differences seen in diabetes management (8.47 [6.11, 10.84]) and treatment burden (6.95 [4.83, 9.07]). GTEE scores showed a greater proportion of participants and physicians rated a complete or marked improvement of diabetes control with iGlarLixi (80.5%, 82.8%) versus BIAsp 30 (63.3%, 65.1%) at week 26. Post hoc analyses showed that after adjusting for HbA1c, body weight and hypoglycaemia outcomes, iGlarLixi continued to show greater improvements in TRIM-D total scores versus BIAsp 30. CONCLUSIONS: In addition to better glycaemic control, weight benefit and less hypoglycaemia, once-daily iGlarLixi provided improved diabetes management, treatment burden and perceived effectiveness versus twice-daily premix BIAsp 30, further supporting iGlarLixi as an advanced treatment option in people with suboptimally controlled T2D on basal insulin plus OADs.

Management of the T2D Patient With High A1C.

It is widely known that the extent of time spent in a state of hyperglycemia increases the risk of complications for patients with type 2 diabetes (T2D). However, despite the availability of many antihyperglycemic agents, success in managing T2D has not dramatically improved in recent years. Indeed, therapeutic inertia-the failure to initiate or intensify treatment-is a well-characterized phenomenon. In this roundtable, the speakers discuss the management of individuals with A1C ≥9% despite treatment with 2 or 3 oral antihyperglycemic agents, who represent a large patient population requiring treatment intensification. The speakers first discuss the severity of complications emanating from lack of glycemic control, and the effect of beta-cell loss on glycemic control. They recount findings that approximately 50% of beta-cell function has been lost at diagnosis, and discuss the impact of beta-cell loss on treatment considerations. Next, the speakers discuss treatment options, in particular, glucagon-like peptide-1 receptor agonists -1(GLP-1 RAs). -1(GLP-1 RAs) can preserve beta-cell function, in patients with T2D duration of up to 10 years, but have been shown to exhibit reduced efficacy in patients with longer T2D duration. They go on to discuss iGlarLixi and iDegLira (fixed-ratio combinations of insulin glargine/ lixisenatide and insulin degludec/liraglutide, respectively), which have been shown to be effective in patients with A1C ≥9%. The speakers discuss the positive outcomes associated with a shorter interval between diagnosis and intensive insulin treatment, and the benefits of timely treatment intensification. They also provide practical advice for counseling patients to achieve an effective transition to injectable medication.