L'efficience thérapeutique : une préoccupation importante. L'exemple des bithérapies injectables dans le diabète de type 2

Improving the efficiency of diabetes medications should be aimed at reducing the ambient hyperglycemia, body weight, glycemic variability, the risk of hypoglycemia and the treatment costs whilst preserving the patient's priorities, quality of life and satisfaction. We report and analyze the situation of a 65-year-old woman who, after 20 years of diabetes, and an escalation of oral antidiabetic drugs required insulin. Subsequently it became necessary to introduce an injectable dual therapy combining a basal insulin with a GLP-1 receptor agonist (GLP-1 RA) to cope with weight gain and glycemic values that were largely above the objectives. The different options are discussed, depending on the number of injections required, daily costs, and of course the data of large studies covering both the different long-acting insulin and GLP-1 RA preparations available in France. In the current state of the patient's characteristics and therapeutic choices, the dulaglutide-glargine (U100 or U300) strategy seems in terms of efficiency to offer two advantages: firstly, to allow a better quality of life by reducing the burden of injections and, secondly, to provide a less costly option than those currently available in France with similar efficacy and safety. Finally, careful consideration should be given to the patient's priorities for making the final decision.