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Aims  To assess whether people with type 2 diabetes transferring from higher basal insulin doses (> 20 units) to a starting dose of 16 units of insulin degludec/liraglutide ( ID egLira) benefit from  ID egLira with/without transient loss of glycaemic control.    Methods   Post hoc  analysis of  DUAL  V and  VII  assessed fasting self‐measured blood glucose ( SMBG ) over weeks 1–8, changes in HbA 1c,  body weight and mean insulin dose over 26 weeks, and percentage of participants achieving HbA 1c  < 53 mmol/mol (7.0%) by end of trial in participants with type 2 diabetes uncontrolled with basal insulin.  ID egLira was compared with continued up‐titration of insulin glargine ( IG lar U100) in  DUAL  V, or switching to basal–bolus therapy in  DUAL VII  ( IG lar U100 and insulin aspart), across pre‐trial insulin dose groups (20–29, 30–39 and 40–50 units/day).    Results  In all subgroups, participants treated with  ID egLira experienced significant improvements in HbA 1c  by end of trial, which were greater than with  IG lar U100 up‐titration (estimated treatment difference –5.86, –6.59 and –6.91 mmol/mol for pre‐trial insulin doses of 20–29, 30–39 and 40–50 units/day, respectively) and similar to basal–bolus therapy (estimated treatment difference –0.16, –1.0 and –0.01 mmol/mol for pre‐trial insulin doses of 20–29, 30–39 and 40–50 units/day, respectively). Compared with  IG lar U100 and basal–bolus therapy,  ID egLira participants experienced weight loss vs. weight gain, lower rates of hypoglycaemia and a lower mean end of trial total daily insulin dose. In both trials, mean fasting  SMBG  decreased from weeks 1 to 8 across all subgroups, despite a temporary increase in mean fasting  SMBG  in the 40–50 units pre‐trial insulin dose group during week 1 [mean increase ( sd ) +1.1 (2.0) mmol/l for  DUAL  V and +1.1 (2.1) mmol/l for  DUAL VII ], which reverted to baseline by week 4.    Conclusions  Regardless of pre‐trial insulin dose,  ID egLira resulted in improved clinical outcomes, even in participants transferring from 40–50 units of basal insulin, despite a transient (< 4 weeks), clinically non‐relevant, elevation in pre‐breakfast  SMBG . (Clinical Trial Registry Number  NCT 01952145 and  NCT 02420262).

diabetic medicine

Insulin degludec/liraglutide ( ID egLira) maintains glycaemic control and improves clinical outcomes, regardless of pre‐trial insulin dose, in people with type 2 diabetes that is uncontrolled on basal insulin