Skip to main content
Top
Published in: Diabetology International 1/2020

01-01-2020 | Insulins | Original Article

Combination use of liraglutide and insulin to Japanese patients with multiple insulin injection: efficacy and cost

Authors: Sellami-Mnif Houda, Umehara Toshihiro, Yamazaki Yuriko, Otake Hiroyuki, Matoba Reie, Sakashita Anna, Matsuda Masafumi

Published in: Diabetology International | Issue 1/2020

Login to get access

Abstract

Objectives

The introduction of liraglutide in the treatment of patients with type 2 diabetes already taking insulin is still subject to discussion in terms of timing and benefits. Gradually intensive insulin therapy is hastily prescribed. Switching from multiple insulin injection (MII) to insulin and liraglutide is evaluated in this study.

Methodology

We studied 92 patients with type 2 diabetes previously under MII, C-peptide ≥ 1.5 ng/ml, divided into a group with reasonable glycemic control [RC: HbA1c < 8% (64 mmol/mol)] and another with a poor control [PC: HbA1c ≥ 8%, (64 mmol/mol)] after introduction of liraglutide and insulin therapy.

Results

Except for HbA1c, there were no statistical differences between RC and PC groups. Basal insulin doses were adjusted to achieve the fasting plasma glucose of 90–120 mg/dl. HbA1c was significantly improved in both groups, from 9.6% ± 1.6 (81 mmol/mol) and 7.0% ± 0.6 (53 mmol/mol) to 8.0% ± 1.5 (64 mmol/mol) and 6.8 ± 0.5% (51 mmol/mol). Reduction of body weight was significant only in RC (from 70 ± 16 kg to 68 ± 16 kg, p < 0.01). All patients from RC group and 58% of PC group reached HbA1c < 8% without hypoglycemia.

Conclusion

This observation persuades us to propose the liraglutide and insulin combination to patients with C-peptide ≥ 1.5 ng/ml, regardless of the HbA1c.
Literature
1.
go back to reference World Health Organization. Global report on diabetes. Geneva: World Health Organization; 2016. World Health Organization. Global report on diabetes. Geneva: World Health Organization; 2016.
3.
go back to reference Seuring T, Archangelidi O, Suhrcke M. The economic costs of type 2 diabetes: a global systematic review. Pharmacoeconomics. 2015;33:811–31.CrossRef Seuring T, Archangelidi O, Suhrcke M. The economic costs of type 2 diabetes: a global systematic review. Pharmacoeconomics. 2015;33:811–31.CrossRef
5.
go back to reference Hiroshi I, Nobuya I, Kohjiro U, Haruhiko O, Hideki K, Disuke K, Yasushi T, Narihito Y, Satoshi I. Treatment guide for diabetes. Japan Diabetes Society; 2014–2015. Hiroshi I, Nobuya I, Kohjiro U, Haruhiko O, Hideki K, Disuke K, Yasushi T, Narihito Y, Satoshi I. Treatment guide for diabetes. Japan Diabetes Society; 2014–2015.
6.
go back to reference American Diabetes Association. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes 2018. Diabetes Care. 2018;41(Supplement 1):S73–85.CrossRef American Diabetes Association. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes 2018. Diabetes Care. 2018;41(Supplement 1):S73–85.CrossRef
7.
go back to reference Donath MY, Ehses JA, Maedler K, Schumann DM, Ellingsgaard H, Eppler E, Reinecke M. Mechanisms of beta-cell death in type 2 diabetes. Diabetes. 2005;54(Suppl 2):108–13.CrossRef Donath MY, Ehses JA, Maedler K, Schumann DM, Ellingsgaard H, Eppler E, Reinecke M. Mechanisms of beta-cell death in type 2 diabetes. Diabetes. 2005;54(Suppl 2):108–13.CrossRef
8.
go back to reference Drucker DJ, Nauck MA. The incretin system: glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes. Lancet. 2006;368(9548):1696–705.CrossRef Drucker DJ, Nauck MA. The incretin system: glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes. Lancet. 2006;368(9548):1696–705.CrossRef
9.
go back to reference Qualmann C, Nauck MA, Holst JJ, Orskov C, Creutzfeldt W. Insulinotropic actions of intravenous glucagon-like peptide-1 (GLP-1) [7–36 amide] in the fasting state in healthy subjects. Acta Diabetol. 1995;32:13–6.CrossRef Qualmann C, Nauck MA, Holst JJ, Orskov C, Creutzfeldt W. Insulinotropic actions of intravenous glucagon-like peptide-1 (GLP-1) [7–36 amide] in the fasting state in healthy subjects. Acta Diabetol. 1995;32:13–6.CrossRef
10.
go back to reference Prasad-Reddy L, Isaacs D. A clinical review of GLP-1 receptor agonists: efficacy and safety in diabetes and beyond. Drugs Context. 2015;4:212–83.CrossRef Prasad-Reddy L, Isaacs D. A clinical review of GLP-1 receptor agonists: efficacy and safety in diabetes and beyond. Drugs Context. 2015;4:212–83.CrossRef
11.
go back to reference Drucker DJ. Enhancing incretin action for the treatment of type 2 diabetes. Diabetes Care. 2003;26(10):2929–40.CrossRef Drucker DJ. Enhancing incretin action for the treatment of type 2 diabetes. Diabetes Care. 2003;26(10):2929–40.CrossRef
12.
go back to reference Wajchenberg BL. β-cell failure in diabetes and preservation by clinical treatment. Endocr Rev. 2007;28(2):187–218.CrossRef Wajchenberg BL. β-cell failure in diabetes and preservation by clinical treatment. Endocr Rev. 2007;28(2):187–218.CrossRef
13.
go back to reference Wettergren A, Schjoldager B, Mortensen PE, Myhre J, Christiansen J, Holst JJ. Truncated GLP-1 (proglucagon 78–107-amide) inhibits gastric and pancreatic functions in man. Dig Dis Sci. 1993;38:665–73.CrossRef Wettergren A, Schjoldager B, Mortensen PE, Myhre J, Christiansen J, Holst JJ. Truncated GLP-1 (proglucagon 78–107-amide) inhibits gastric and pancreatic functions in man. Dig Dis Sci. 1993;38:665–73.CrossRef
14.
go back to reference Larsen PJ, Fledelius C, Knudsen LB, Tang-Christensen M. Systemic administration of the long-acting GLP-1 derivative NN2211 induces lasting and reversible weight loss in both normal and obese rats. Diabetes. 2001;50:2530–9.CrossRef Larsen PJ, Fledelius C, Knudsen LB, Tang-Christensen M. Systemic administration of the long-acting GLP-1 derivative NN2211 induces lasting and reversible weight loss in both normal and obese rats. Diabetes. 2001;50:2530–9.CrossRef
15.
go back to reference Donahey JCK, Van Dijk G, Woods SC, Seeley RJ. Intraventricular GLP-1 reduces short but not long-term food intake or body weight in lean and obese rats. Brain Res. 1998;779:75–83.CrossRef Donahey JCK, Van Dijk G, Woods SC, Seeley RJ. Intraventricular GLP-1 reduces short but not long-term food intake or body weight in lean and obese rats. Brain Res. 1998;779:75–83.CrossRef
16.
go back to reference Eng C, Kramer CK, Zinman B, Retnakaran R. Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis. Lancet. 2015;384(9961):2228–34.CrossRef Eng C, Kramer CK, Zinman B, Retnakaran R. Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis. Lancet. 2015;384(9961):2228–34.CrossRef
18.
go back to reference Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JFE, Nauck MA, Nissen SE, Pocock S, Poulter NR, Ravn LS, Steinberg WM, Stockner M, Zinman B, Bergenstal RM, Buse JB, LEADER Steering Committee, LEADER Trial Investigators. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375:311–22.CrossRef Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JFE, Nauck MA, Nissen SE, Pocock S, Poulter NR, Ravn LS, Steinberg WM, Stockner M, Zinman B, Bergenstal RM, Buse JB, LEADER Steering Committee, LEADER Trial Investigators. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375:311–22.CrossRef
21.
go back to reference Pi-Sunyer X, Astrup A, Fujioka K, Greenway F, Halpern A, Krempf M, Lau DCW, le Roux CW, Violante Ortiz R, Jensen CB, Wilding JPH. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med. 2015;373:11–22.CrossRef Pi-Sunyer X, Astrup A, Fujioka K, Greenway F, Halpern A, Krempf M, Lau DCW, le Roux CW, Violante Ortiz R, Jensen CB, Wilding JPH. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med. 2015;373:11–22.CrossRef
22.
go back to reference Toyoda M, Yokoyama H, Abe K, Nakamura S, Suzuki D. Predictors of response to liraglutide in Japanese type 2 diabetes. Diabetes Res Clin Pract. 2014;106(3):451–7.CrossRef Toyoda M, Yokoyama H, Abe K, Nakamura S, Suzuki D. Predictors of response to liraglutide in Japanese type 2 diabetes. Diabetes Res Clin Pract. 2014;106(3):451–7.CrossRef
23.
go back to reference Ito D, Iuchi T, Kurihara S, Inoue I, Katayama S, Inukai K. Efficacy and clinical characteristics of liraglutide in japanese patients with type 2 diabetes. J Clin Med Res. 2015;7(9):694–9.CrossRef Ito D, Iuchi T, Kurihara S, Inoue I, Katayama S, Inukai K. Efficacy and clinical characteristics of liraglutide in japanese patients with type 2 diabetes. J Clin Med Res. 2015;7(9):694–9.CrossRef
25.
go back to reference Holman RR, Thorne KI, Farmer AJ, et al. Addition of biphasic, prandial, or basal insulin to oral therapy in type 2 diabetes. N Engl J Med. 2007;357:1716–30.CrossRef Holman RR, Thorne KI, Farmer AJ, et al. Addition of biphasic, prandial, or basal insulin to oral therapy in type 2 diabetes. N Engl J Med. 2007;357:1716–30.CrossRef
26.
go back to reference Rys P, Wojciechowski P, Siejka S, Małecki P, Hak L, Malecki MT. A comparison of biphasic insulin aspart and insulin glargine administered with oral antidiabetic drugs in type 2 diabetes mellitus—a systematic review and meta-analysis. Int J Clin Pract. 2014;68(3):304–13.CrossRef Rys P, Wojciechowski P, Siejka S, Małecki P, Hak L, Malecki MT. A comparison of biphasic insulin aspart and insulin glargine administered with oral antidiabetic drugs in type 2 diabetes mellitus—a systematic review and meta-analysis. Int J Clin Pract. 2014;68(3):304–13.CrossRef
27.
go back to reference Reid T, Gao L, Gill J, Stuhr A, Traylor L, Vlajnic A, Rhinehart A. How much is too much? Outcomes in patients using high-dose insulin glargine. Int J Clin Pract. 2016;70(1):56–65.CrossRef Reid T, Gao L, Gill J, Stuhr A, Traylor L, Vlajnic A, Rhinehart A. How much is too much? Outcomes in patients using high-dose insulin glargine. Int J Clin Pract. 2016;70(1):56–65.CrossRef
28.
go back to reference Mayfield JA, White RD. Insulin therapy for type 2 diabetes: rescue, augmentation, and replacement of beta-cell function. Am Fam Physician. 2004;70(3):489–500.PubMed Mayfield JA, White RD. Insulin therapy for type 2 diabetes: rescue, augmentation, and replacement of beta-cell function. Am Fam Physician. 2004;70(3):489–500.PubMed
29.
go back to reference Garber AJ. Long-acting glucagon-like peptide 1 receptor agonists: a review of their efficacy and tolerability. Diabetes Care. 2011;34(2):S279–84.CrossRef Garber AJ. Long-acting glucagon-like peptide 1 receptor agonists: a review of their efficacy and tolerability. Diabetes Care. 2011;34(2):S279–84.CrossRef
31.
go back to reference Cefalu WT, Buse JB, Del Prato S, Home PD, LeRoith D, Nauck MA, Raz I, Rosenstock J, Riddle MC. Beyond metformin: safety considerations in the decision-making process for selecting a second medication for type 2 diabetes management: reflections from a diabetes care editors’ expert forum. Diabetes Care. 2014;37(9):2647–59.CrossRef Cefalu WT, Buse JB, Del Prato S, Home PD, LeRoith D, Nauck MA, Raz I, Rosenstock J, Riddle MC. Beyond metformin: safety considerations in the decision-making process for selecting a second medication for type 2 diabetes management: reflections from a diabetes care editors’ expert forum. Diabetes Care. 2014;37(9):2647–59.CrossRef
32.
33.
go back to reference Nauck M, Frid A, Hermansen K, et al. LEAD-2 Study Group. Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes: the LEAD (liraglutide effect and action in diabetes)-2 study. Diabetes Care. 2009;32:84–90.CrossRef Nauck M, Frid A, Hermansen K, et al. LEAD-2 Study Group. Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes: the LEAD (liraglutide effect and action in diabetes)-2 study. Diabetes Care. 2009;32:84–90.CrossRef
34.
go back to reference Rosenstock J, Brazg R, Andryuk PJ, Lu K, Stein P. Sitagliptin Study 019 Group. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor sitagliptin added to ongoing pioglitazone therapy in patients with type 2 diabetes: a 24-week, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Clin Ther. 2006;28:1556–68.CrossRef Rosenstock J, Brazg R, Andryuk PJ, Lu K, Stein P. Sitagliptin Study 019 Group. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor sitagliptin added to ongoing pioglitazone therapy in patients with type 2 diabetes: a 24-week, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Clin Ther. 2006;28:1556–68.CrossRef
35.
go back to reference Seino Y, Rasmussen MF, Nishida T, Kaku K. Efficacy and safety of the once-daily human GLP-1 analogue, liraglutide, vs glibenclamide monotherapy in Japanese patients with type 2 diabetes. Curr Med Res Opin. 2010;26(5):1013–22.CrossRef Seino Y, Rasmussen MF, Nishida T, Kaku K. Efficacy and safety of the once-daily human GLP-1 analogue, liraglutide, vs glibenclamide monotherapy in Japanese patients with type 2 diabetes. Curr Med Res Opin. 2010;26(5):1013–22.CrossRef
36.
go back to reference Seino Y, Rasmussen MF, Zdravkovic M, Kaku K. Dose-dependent improvement in glycemia with once-daily liraglutide without hypoglycemia or weight gain: a double-blind, randomized, controlled trial in Japanese patients with type 2 diabetes. Diabetes Res Clin Pract. 2008;81(2):161–8.CrossRef Seino Y, Rasmussen MF, Zdravkovic M, Kaku K. Dose-dependent improvement in glycemia with once-daily liraglutide without hypoglycemia or weight gain: a double-blind, randomized, controlled trial in Japanese patients with type 2 diabetes. Diabetes Res Clin Pract. 2008;81(2):161–8.CrossRef
37.
go back to reference Fukushima M, et al. Insulin secretion capacity in the development from normal glucose tolerance to type 2 diabetes. Diabetes Res Clin Pract. 2004;66(Suppl 1):S37–43.CrossRef Fukushima M, et al. Insulin secretion capacity in the development from normal glucose tolerance to type 2 diabetes. Diabetes Res Clin Pract. 2004;66(Suppl 1):S37–43.CrossRef
38.
go back to reference Chan JC, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301:2129–40.CrossRef Chan JC, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301:2129–40.CrossRef
39.
go back to reference Yabe D, Kuwata H, Iwasaki M, Seino Y. Why are incretin-based therapies more efficient in East Asian? Perspectives from the pathophysiology of type 2 diabetes and East Asian dietary habits. EMJ Diabet. 2015;3(1):57–65. Yabe D, Kuwata H, Iwasaki M, Seino Y. Why are incretin-based therapies more efficient in East Asian? Perspectives from the pathophysiology of type 2 diabetes and East Asian dietary habits. EMJ Diabet. 2015;3(1):57–65.
Metadata
Title
Combination use of liraglutide and insulin to Japanese patients with multiple insulin injection: efficacy and cost
Authors
Sellami-Mnif Houda
Umehara Toshihiro
Yamazaki Yuriko
Otake Hiroyuki
Matoba Reie
Sakashita Anna
Matsuda Masafumi
Publication date
01-01-2020
Publisher
Springer Japan
Published in
Diabetology International / Issue 1/2020
Print ISSN: 2190-1678
Electronic ISSN: 2190-1686
DOI
https://doi.org/10.1007/s13340-019-00404-x

Other articles of this Issue 1/2020

Diabetology International 1/2020 Go to the issue