On 2016 Apr 16, David Keller commented:
Your helpful explanations clarify the study protocol very well. I have deleted my erroneous comments which were based, as you correctly noted, on a misunderstanding. Thank you, Dr. Buse.
On 2016 Apr 05, John B Buse commented:
I believe that you have misunderstood the protocol. At randomization, those assigned to the combination of insulin degludec and liraglutide (IDegLira) stopped their glargine and started 16 dose-steps of IDegLira (16 units of degludec and 0.6 mg of liraglutide. They then titrated IDegLira twice a week based on their average fasting plasma glucose by -2, 0 or +2 dose steps of IDegLira aiming for a fasting plasma glucose of 72-90 mg/dl. The maximum dose of IDegLira was 50 dose steps (50 units of insulin degludec and 1.8 mg of liraglutide). The IDegLira patients did not continue the glargine. So, our conclusion is that for patients inadequately controlled on glargine 20-50 units, switching glargine to IDegLira is superior to continued titration of glargine. There is a remaining question as to what to do with a patient inadequately controlled on the maximum dose of IDegLira. That has not been studied as of yet.
On 2016 Mar 10, David Keller commented:
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On 2016 Mar 09, John B Buse commented:
As explained in the paper, the comparison was made to glargine to examine the common clinical scenario of inadequately controlled diabetes treated with basal insulin. Glargine is the most commonly prescribed insulin formulation in the world. There are prior comparisons of IDegLira versus degludec in DUAL-1 (Gough, et al. Lancet Diabetes Endocrinol. 2014 PMID: 25190523) and in DUAL-2 (Buse, et al. Diabetes Care 2014. PMID: 25114296). There are also studies that have compared glargine to degludec head to head, e.g., Rodbard Diabet Med. 2013 PMID: 23952326. Thank you for your comment.
On 2016 Mar 09, David Keller commented:
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On 2016 Mar 09, David Keller commented:
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