Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-80

• Mean body weight change: iGlarLixi -0.3 kg, Lixi -2.3 kg, iGlar +1.1 kg; difference 1.4 kg, p<0.0001). • Rates of symptomatic hypoglycemia: Similar with iGlarLixi and insulin glargine (1.4 and 1.2 events/patient-year) and less with lixisenatide (0.3 events/patient-year). • Fewer GI events: iGlarLixi vs lixisenatide (nausea (9.6% vs. 24%), vomiting (3.2% vs. 6.4%). Xultophy ® : Insulin degludec U-100 + liraglut ide 3.6mg (198) Indication: Type 2 diabetes in combination with metformin, with or without sulfonylurea, when these combined with basal insulin (< 50 units daily) or liraglutide (less than or equal to 1.8 mg daily), do not provide adequate glycemic control. Discontinue therapy with liraglutide or basal insulin prior to initiation of Xultophy ® . • Starting dose : 16 units (16 units of insulin degludec and 0.58 mg liraglutide) o Each unit contains 1 unit of degludec and 0.04 mg liraglutide (fixed ratio) • Administration : Same time once daily (with or without food). • Titrate : 2 units every three to four days based on the fasting BG (or hypoglycemia). • Maximum dose : 50 units (50 units of insulin degludec and 1.8 mg liraglutide). To minimize the risk of hypoglycemia or hyperglycemia, additional titration may be needed with changes in physical activity, meal patterns (i.e., macronutrient content or timing of food intake), or renal or hepatic function; during acute illness; or when used with other medications. Soliqua™: Insulin glargine U-100/lixisenat ide 33 mcg/mL (199) Concentration 100 units of insulin glargine per mL and 33 mcg of lixisenatide per mL in a 3 mL. • Indication: Type 2 diabetes on basal insulin (< 60 units daily) alone or in combination with metformin. o Discontinue therapy with lixisenatide or basal insulin prior to initiation. • Starting dose : o 15 units insulin glargine U ‐ 100 (5 mcg lixisenatide): If taking <30 units basal insulin daily. o 30 units insulin glargine U ‐ 100 (10 mcg lixisenatide): If taking 30 ‐ 60 units basal insulin daily.