Evaluating remission of type 2 diabetes using a metabolic intervention including fixed-ratio insulin degludec and liraglutide: A randomized controlled trial.

Autor: Punthakee Z; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.; Population Health Research Institute, Hamilton, Ontario, Canada., Hall S; Population Health Research Institute, Hamilton, Ontario, Canada., McInnes N; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.; Population Health Research Institute, Hamilton, Ontario, Canada., Sherifali D; Population Health Research Institute, Hamilton, Ontario, Canada.; School of Nursing, McMaster University, Hamilton, Ontario, Canada., Tsiplova K; Population Health Research Institute, Hamilton, Ontario, Canada., Kirabo FR; Population Health Research Institute, Hamilton, Ontario, Canada., Ransom TPP; Capital Health, Halifax, Nova Scotia, Canada., Harris SB; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Lochnan HA; Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada., Sigal RJ; Department of Medicine, Cardiac Sciences and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada., Ghosh M; Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada., Spaic T; Department of Medicine, Western University and Lawson Health Research Institute, London, Ontario, Canada., Gerstein HC; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.; Population Health Research Institute, Hamilton, Ontario, Canada.
Jazyk: angličtina
Zdroj: Diabetes, obesity & metabolism [Diabetes Obes Metab] 2024 Dec; Vol. 26 (12), pp. 5600-5608. Date of Electronic Publication: 2024 Sep 06.
DOI: 10.1111/dom.15926
Abstrakt: Aim: To evaluate the effect on type 2 diabetes remission of short-term intensive metabolic intervention consisting of frequent dietary, exercise and diabetes management coaching, metformin and fixed-ratio insulin degludec/liraglutide.
Methods: In a multicentre open-label randomized controlled trial, insulin-naïve participants within 5 years of diabetes diagnosis were assigned to a 16-week remission intervention regimen or standard care, and followed for relapse of diabetes and sustained remission for an additional year after stopping glucose-lowering drugs.
Results: A total of 159 participants aged 57 ± 10 years, with diabetes duration 2.6 ± 1.5 years, body mass index 33.5 ± 6.5 kg/m 2 , and glycated haemoglobin (HbA1c) level 53 ± 7 mmol/mol were randomized and analysed (79 intervention, 80 control). At the end of the 16-week intervention period, compared to controls, intervention participants achieved lower HbA1c levels (40 ± 4 vs. 51 ± 7 mmol/mol; p < 0.0001), and lost more weight (3.3 ± 4.4% vs. 1.9 ± 3.0%; p = 0.02). There was a lower hazard of diabetes relapse overall in the intervention group compared to controls (hazard ratio 0.63, 95% confidence interval [CI] 0.45, 0.88; p = 0.007), although this was not sustained over time. Remission rates in the intervention group were not significantly higher than in the control group at 12 weeks (17.7% vs. 12.5%, relative risk [RR] 1.42, 95% CI 0.67, 3.00; p = 0.36) or at 52 weeks (6.3% vs. 3.8%, RR 1.69, 95% CI 0.42, 6.82) following the intervention period.
Conclusions: An intensive remission-induction intervention including fixed-ratio insulin degludec/liraglutide reduced the risk of type 2 diabetes relapse within 1 year without sustained remission.
(© 2024 The Author(s). Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
Externí odkaz: