ORLANDO — Among patients with uncontrolled type 2 diabetes with very high HbA1c, two treatment regimens led to "dramatic improvements" in glycemic control at 6 months, but one strategy stood out, researchers report.That is, initiating a treatment regimen of basal insulin plus the glucagon-like peptide-1 (GLP-1) receptor agonist liraglutide (Victoza, Novo Nordisk) was more effective at lowering HbA1c than a regimen of basal plus bolus insulin in the randomized SIMPLE study, which was sponsored by Novo Nordisk.Marconi Abreu, MD, from the UT Southwestern Medical Center, Dallas, Texas, presented these findings here at the American Diabetes Association (ADA) 2018 Scientific Sessions."In summary, this is the first and only trial that compares two strategies suggested by the ADA for patients with HbA1c above 10%," he said. "It showed that a strategy based on [basal insulin plus a GLP-1 receptor agonist] was superior to a strategy of basal-bolus insulin, with an estimated treatment difference [in attained HbA1c] of -1.1%."Importantly, he noted, more patients in the group that received basal insulin plus the GLP-1 receptor agonist achieved a target HbA1c below 7% at 6 months, and this group of patients also attained "a better weight profile, less hypoglycemia, and improvement in quality of life — all that with fewer insulin injections."Two things about the trial stood out for session chair Tricia Santos Cavaiola, MD, an endocrinologist at UC San Diego Health, in California.First, "I think it is an unmet need," she told Medscape Medical News. "More trials are needed in that patient population because we certainly do see [patients with type 2 diabetes with very elevated HbA1c levels], and the guidelines are not as clear in terms of what to do."Second, "the patients that were started on basal-bolus therapy were started on...four injections a day," whereas "most often when we start patients on combination basal-bolus therapy they're usually already on basal insulin...and typically we add one dose of bolus insulin with the largest meal and progress as needed."She wondered if part of the lower compliance in that group was related to the four injections a day, which those patients may have found were "too much or too complicated a regimen,” as compared with the once-a-day injections of the other group.