Session Two: Changing the Type 2 Diabetes Mellitus Management Paradigm with Fixed-Ratio Combinations
This Sanofi sponsored symposium, titled ‘Evolving Standards and Innovation in Diabetes Care’, took place on 11th September 2017, as a part of the 53rd Annual Meeting of the European Association for the Study of Diabetes (EASD) in Lisbon, Portugal
Symposium Chair: Elizabeth Seaquist1
Session Chair: Julio Rosenstock2
Speakers: James R. Gavin III,3 Neil Skolnik,4 Lucia Novak5
1. University of Minnesota, Minneapolis, Minnesota, USA
2. Dallas Diabetes Research Center at Medical City, Dallas, Texas, USA
3. Emory University School of Medicine, Atlanta, Georgia, USA
4. Thomas Jefferson University, Philadelphia, Pennsylvania, USA
5. Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
Disclosure: Elizabeth Seaquist has been a consultant, advisor, or received honoraria from the American Board of Internal Medicine, American Diabetes Association, Eli Lilly, Endocrine Society, Locemia, Novo Nordisk, and Zucera. She has received research support from Eli Lilly, Juvenile Diabetes Research Foundation, and the National Institutes of Health, and has received travel/speaker reimbursement from the American Board of Internal Medicine, American Diabetes Association, Eli Lilly, Endocrine Society, National Institutes of Health, and Novo Nordisk. Julio Rosenstock has received research support from Merck, Pfizer, Sanofi, Novo Nordisk, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, AstraZeneca, Lexicon, Janssen, Daiichi Sankyo, Intarcia, Hanmi, Genentech, and Boehringer Ingelheim. He has also been a consultant and participated in advisory boards for Novo Nordisk, Sanofi, Eli Lilly, Daiichi Sankyo, AstraZeneca, Intarcia, Janssen, and Boehringer Ingelheim. James R. Gavin III has served as a board member and as part of an advisory panel for Abbott Diabetes Care, Janssen, Merck, Novo Nordisk, and Intarcia. He has also been a consultant for Boehringer Ingelheim/Lilly Alliance and Janssen and has been part of the speaker’s bureau for AstraZeneca, Boehringer Ingelheim/Lilly Alliance, Janssen, Merck, and Novo Nordisk. Neil Skolnik has participated in advisory boards for AstraZeneca, Boehringer Ingelheim, Intarcia, Janssen, Eli Lilly, Sanofi, and Teva. He has served as a speaker for AstraZeneca and Boehringer Ingelheim and has received research support from AstraZeneca and Sanofi. Lucia Novak has provided consulting services to CeQur SA and Intarcia, participated in advisory boards for Sanofi, and served as a speaker for AstraZeneca, Janssen, and Novo Nordisk.
Acknowledgements: Writing assistance was provided by Dr Lisa Michel, Ashfield Healthcare Communications Ltd., London, UK.
Support: The publication of this article was funded by Sanofi. The views and opinions expressed are those of the speakers and not necessarily of Sanofi.
Citation: EMJ Diabet. 2017;5:46-55.
Fixed-ratio combinations, the co-administration of two injectable therapies in a formulation that can be adjusted through titration, are changing the Type 2 diabetes mellitus management paradigm. Current treatment guidelines for glucose control rely heavily on a stepwise approach; however, that can be inconsistently followed and relatively indifferent to the complex pathophysiology of Type 2 diabetes mellitus. Fixed-ratio combinations have targeted actions that complement other treatments. Basal insulin plus a glucagon-like peptide 1 receptor agonist (GLP-1 RA) represent one such combination that offers an efficacious approach to control both fasting and postprandial glucose, key determinants of glycaemic and clinical outcomes.
Two fixed-ratio combinations, insulin glargine 100 U/mL plus lixisenatide (iGlarLixi) and insulin degludec plus liraglutide (IDegLira), are currently available in the European Union (EU) and USA. Clinical evidence from pivotal, Phase III trials with iGlarLixi and IDegLira have demonstrated their robust glycated haemoglobin (HbA1c)-lowering effects, which are associated with mitigation of side effects commonly experienced with the individual components, including basal insulin-related body weight gain and GLP-1-related gastrointestinal adverse events. The spectrum of clinical benefits associated with these titratable fixed-ratio combinations may offer a more compelling case for earlier and effective use of these therapies that better addresses the complex underlying pathophysiology of Type 2 diabetes mellitus.
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