Simplification of complex insulin regimens feasible in well-controlled diabetes

In patients with well-controlled type 2 diabetes, complex insulin regimens can be simplified by maintaining only basal insulin support and replacing all boluses with once-daily canagliflozin or liraglutide, a recent study has shown.

Thirty-four patients participated in the study, all of whom had glycated haemoglobin (HbA1c) levels <7.5 percent, kept under control by multiple daily insulin injections. For 24 weeks, well bolus insulin was randomly replaced by either 100-mg/day canagliflozin or 0.3–0.9-mg/day liraglutide (17 patients in each group), along with maintenance of basal insulin.

Study endpoints were the change in HbA1c, quality of life, safety, body mass index (BMI), and glycaemic variability measured by continuous glucose monitoring.

After 24 weeks of simplification, HbA1c levels remained well-controlled in both the canagliflozin and liraglutide groups, with respective values of 6.7±0.7 percent and 6.2±0.8 percent. The change from baseline was not statistically different between groups.

Moreover, 10 patients in the canagliflozin group and 11 in the liraglutide group saw improved HbA1c levels relative to baseline.

As expected, total insulin dose decreased significantly in both groups: by 34 percent and 48 percent in the canagliflozin and liraglutide arms, respectively. This was mostly driven by the drop in bolus insulin, though basal insulin doses significantly increased from baseline (45 percent in canagliflozin and 39 percent in liraglutide).

Quality of life significantly improved with treatment simplification, along with a reduction in body weight and BMI. No changes were reported in glucose variability.

In terms of safety, one patient in the canagliflozin had a hyperglycaemic episode, with HbA1c reaching ≥9.0 percent. There were no severe adverse events.