BEYOND 2 years: durability of metabolic benefits by simplification of complex insulin regimens in type 2 diabetes

Purpose To assess the magnitude and durability of the metabolic benefits by simplification of complex insulin treatments in patients with type 2 diabetes inadequately controlled by a full basal-bolus insulin regimen. Herein we report the results of the scheduled 2-year extension of the BEYOND trial.Methods Originally, 305 participants with inadequate glycemic control (HbA1c > 7.5%) were randomly assigned to intensification of basal-bolus insulin regimen (n = 101), to a fixed-ratio combination (basal insulin + GLP-1RA, n = 102), or to an association of basal insulin plus an SGLT-2 inhibitor (gliflo-combo, n = 102). The primary efficacy outcome was change from baseline in HbA1c at 24 months assessed by an intention-to-treat analysis. A per-protocol analysis was also performed.Results Fifty-five percent of patients completed the study in the two comparison arms. Compared with patients randomized to basal-bolus, patients of the other groups experienced non statistically different reductions in HbA1c level according to either an intention-to-treat analysis (-0.8 +/- 1.1%, -0.7 +/- 1.1%, and -1.3 +/- 1.1%, mean +/- SD, fixed-ratio, gliflo-combo and basal bolus, respectively) or per-protocol analysis (-1.2 +/- 1.0%, -1.2 +/- 1.1%, and -1.3 +/- 1.0%, respectively). The final HbA1c level (per protocol) was 7.2 +/- 0.8%, 7.3 +/- 0.9%, and 7.5 +/- 0.9%, respectively (P = NS). Treatment satisfaction (DTSQ) increased in both exchange groups, whereas the proportion of patients with hypoglycemia was lower.Conclusion Simplification of complex insulin regimen may be a durable option in at least one-half of patients with type 2 diabetes.Clinical trial registration Clinical trial registration no. NCT04196231, clinicaltrials.gov.