Insulin Intensification Strategies in Later-Stage Type 2 Diabetes Mellitus

Introduction

ADA Practice Guidelines

ADA Practice Guidelines (cont)

EDITION I to III Meta-Analysis: Summary

EDITION I to III Meta-Analysis: Severe or Confirmed Hypoglycemia ≤ 3 EDITION I to III Meta-Analysis: Severe or Confirmed Hypoglycemia ≤ 3.9 mmol/L (70 mg/dL)

SWITCH 2: Trial Population

SWITCH: Hypoglycemia Risk Inclusion Criteria

SWITCH 2: HbA1c Over Time - Noninferiority Was Confirmed

SWITCH 2: Overall Symptomatic Hypoglycemia - IDeg Significantly Reduced Overall Symptomatic Hypoglycemia vs IGlar U100

SWITCH 2: Nocturnal Symptomatic Hypoglycemia - IDeg Significantly Reduced Nocturnal Symptomatic Hypoglycemia vs IGlar U100

SWITCH 2: Severe Hypoglycemia - IDeg Significantly Reduced Severe Hypoglycemia vs IGlar U100 in the Full Treatment Period

SWITCH 2 in Perspective: Hypoglycemia - Switch vs Phase 3a Meta-Analysis

DEVOTE: Trial Design

Baseline Medications

Time to First MACE

Incidence of Hypoglycemia

DEVOTE Confirmed the Results From BEGIN and SWITCH in Regard to Hypoglycemia in T2DM

Systematic Review: Association of Hypoglycemia With Outcomes

ADA Practice Guidelines (cont)

Adding a GLP-1 RA to Basal Insulin

Addition of GLP-1 RA to Basal Insulin: Change in HbA1c

Addition of GLP-1 RA to Basal Insulin: Change in Weight

Addition of GLP-1 RA or Bolus Insulin to Basal Insulin Hypoglycemia

Fixed-Ratio Combinations: Advantages

EXTRA: Real World Experience with IDegLira

Data of DUAL VII

EXTRA: Real World Experience with IDegLira (cont)

ADA Practice Guidelines (cont)

Addition of GLP-1 RA or Bolus Insulin to Basal Insulin Hypoglycemia (cont)

Conclusion