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

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.