Objective: In management type 2 diabetes (T2D) , it is required to pursue the A1C <7% Target avoiding hypoglycemia, especially in increased old aged population in Japan. We examined the effectiveness of liraglutide (Lira) and insulin degludec (IDeg) combination therapy in 134 Japanese persons with T2D.
Methods: Hospitalized persons who started this combination therapy since year 2014 were recruited. Changes of HbA1c and basal Insulin doses were evaluated for 4.5 years after discharge. Glycemic variability (GV) was evaluated by ADRR in person who did SMBG. Since preserved β-cell function might influence the management, effectiveness was also compared by duration of T2D ≤ 5-year (SHORT; n=53) or > 5-year (LONG; n=81) . Persons in SHORT were with shorter duration of T2D than LONG (0.67±1.5 vs. 18.7±9.3 years: p<0.0001) , higher C-peptide Index (1.50±0.76 vs. 0.97±0.66: p<0.001) .
Results: 1) Mean HbA1c in total had maintained ≤7.1% from 3rd to 54th month. But mean HbA1C in SHORT was remarkably improved, and had maintained ≤6.6% from 3th until 54th month with extremely lower ADRR score ∼5. 2) At hospitalization, maximum IDeg dose was 15.5±9.2 (6∼46) (SHORT) vs. 14.0±7.6 (4∼40) U/day (LONG) , because of higher HbA1C (12.3±2.3% vs. 10.3±2.4%: p<0.0001) at the baseline. But insulin requirement rapidly decreased in SHORT. On titration, IDeg was titrated not to reach BG <80mg/dL. IDeg could be quitted in ∼75% vs.∼15% at 24th month, respectively. On 3rd month in insulin user, IDeg dose decreased to 7.5±4.1U/day vs. 9.6±5.6U/day, despite lower Lira dose in SHORT with 0.66±0.15mg/day vs. in LONG 0.72±0.23mg/day. 3) Distribution of peak age in total was 70s, and the CKD rate was the more pronounced at 57% (25/44) . Although SHORT group were younger (60.8±11.7 vs. 70.8±11.0 years old: p<0.01) , they already had CKD in 32.1%.
Conclusion: Lira based therapy is useful for attaining HbA1c Target with simple insulin titration, longer durability, and for pursuing reno-protection in whole generation with CKD.
K.Kashima: None. H.Shimizu: None. M.Yamada: None.