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Purpose <p>Managing T2DM in older frail adults is challenging, as age-related sarcopenia and insulin resistance may be worsened by traditional insulin regimens. IDegLira, a fixed-ratio combination of insulin degludec and liraglutide, may simplify therapy and improve body composition.</p> Methods <p>This retrospective analysis of 36 (18 women/18 men) frail insulin-treated older adults (mean age 79.6 ± 5.8&#xa0;years) from the STOP (Simplifying&#xa0;Treatment in&#xa0;Older&#xa0;People) study assessed the impact of switching to once-daily IDegLira. Body composition was measured via bioelectrical impedance analysis (BIA) at baseline and 6&#xa0;months, and changes were evaluated using adjusted mixed models for repeated measures.</p> Results <p>Total insulin dose dropped from 34.52 to 24.30 U/day, and bolus insulin was nearly discontinued, while IDegLira was up titrated from 15.66 to 22.41 units/day. After 6&#xa0;months on IDegLira, body composition controlling for multiple covariates improved significantly: fat-free mass (+ 3.17&#xa0;kg/m), body cell mass (+ 7.82&#xa0;kg/m), phase angle (+ 1.75°), and basal metabolic rate (+ 217.6&#xa0;kcal) all increased (<i>p</i> &lt; 0.001), while fat mass, total body water, and extracellular water decreased (<i>p</i> &lt; 0.001). Weight and BMI were also reduced (–2.6&#xa0;kg and –0.95&#xa0;kg/m<sup>2</sup>, <i>p</i> &lt; 0.001). Glycemic control improved with a favorable trend in reduction in HbA1c (7.29% to 7.05%, <i>p</i> = 0.089), while insulin resistance (METS-IR) declined significantly (42.39 to 32.84, <i>p</i> &lt; 0.0001).</p> Conclusion <p>Switching frail older adults with T2DM to IDegLira improved body composition, metabolic parameters, and reduced insulin needs, filling a critical gap in BIA-based evidence for this population and supporting its use as a safer, simplified alternative to complex insulin regimens.</p>

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Switching from insulin injections to degludec/liraglutide in older frail persons: 6-month body composition remodelling

  • 期刊论文

  • 发表日期：

    2025年7月7日

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  • Francesca Mancinetti,
  • Dionysios Xenos,
  • Michelantonio De Fano,
  • Alessio Mazzieri,
  • Sara Ercolani,
  • Patrizia Mecocci,
  • Francesca Porcellati,
  • Virginia Boccardi

摘要

Purpose

Managing T2DM in older frail adults is challenging, as age-related sarcopenia and insulin resistance may be worsened by traditional insulin regimens. IDegLira, a fixed-ratio combination of insulin degludec and liraglutide, may simplify therapy and improve body composition.

Methods

This retrospective analysis of 36 (18 women/18 men) frail insulin-treated older adults (mean age 79.6 ± 5.8 years) from the STOP (Simplifying Treatment in Older People) study assessed the impact of switching to once-daily IDegLira. Body composition was measured via bioelectrical impedance analysis (BIA) at baseline and 6 months, and changes were evaluated using adjusted mixed models for repeated measures.

Results

Total insulin dose dropped from 34.52 to 24.30 U/day, and bolus insulin was nearly discontinued, while IDegLira was up titrated from 15.66 to 22.41 units/day. After 6 months on IDegLira, body composition controlling for multiple covariates improved significantly: fat-free mass (+ 3.17 kg/m), body cell mass (+ 7.82 kg/m), phase angle (+ 1.75°), and basal metabolic rate (+ 217.6 kcal) all increased (p < 0.001), while fat mass, total body water, and extracellular water decreased (p < 0.001). Weight and BMI were also reduced (–2.6 kg and –0.95 kg/m2, p < 0.001). Glycemic control improved with a favorable trend in reduction in HbA1c (7.29% to 7.05%, p = 0.089), while insulin resistance (METS-IR) declined significantly (42.39 to 32.84, p < 0.0001).

Conclusion

Switching frail older adults with T2DM to IDegLira improved body composition, metabolic parameters, and reduced insulin needs, filling a critical gap in BIA-based evidence for this population and supporting its use as a safer, simplified alternative to complex insulin regimens.