Remission Evaluation of a Metabolic Intervention for Type 2 Diabetes With IDegLira

Inclusion Criteria:

1. men and women aged 30-80 years;
2. T2D diagnosed within 5 years
3. stable T2D drug regimen in the 8 weeks before randomization;
4. HbA1c 6.5-9.5% on no glucose lowering drugs, or 6.5%-8.0% on up to 2 glucose loweringdrugs;
5. body mass index ≥ 23 kg/m2;
6. ability and willingness to perform self-monitoring of capillary blood glucose (SMBG);
7. willingness to wear a continuous glucose monitor on at least 3 occasions;
8. ability and willingness to self-inject IDegLira and insulin;
9. provision of informed consent.

Exclusion Criteria:

1. current use of insulin therapy;
2. history of hypoglycemia unawareness, or severe hypoglycemia requiring assistance;
3. history of end-stage renal disease or eGFR<45 mL/min/1.73 m2 by MDRD formula;
4. active liver disease or elevated alanine transferase (ALT) levels ≥ 2.5 times theupper limit of normal at the time of enrolment;
5. history or clinical suspicion of pancreatitis or medullary thyroid cancer;
6. diagnosis or first degree relative with Multiple Endocrine Neoplasia Type 2 (MEN2);
7. history of diabetic retinopathy requiring photocoagulation, injection therapy orvitrectomy;
8. history of cardiovascular disease (unless cleared for a moderate intensity exerciseprogram by a specialist) including: i. acute coronary syndrome, hospitalization forunstable angina, myocardial infarction, or revascularization with coronary arterybypass grafting or percutaneous coronary intervention; ii. peripheral vasculardisease, valvular heart disease, cardiomyopathy, aortic dissection, tachyarrhythmias,bradyarrhythmias, prior stroke or TIA; iii. prior hospitalization for heart failure;or iv. ECG findings concerning for ischemic heart disease (i.e. pathological Q-waves,ST-segment-T-wave abnormalities in contiguous leads, left anterior hemiblock, leftbundle branch block, second or third degree atrioventricular block).
9. history of any disease requiring frequent intermittent or continuous systemicglucocorticoid treatment;
10. history of bariatric surgery, or planned bariatric surgery in the next 1.5 years;
11. history of any major illness with a life expectancy of < 3 years;
12. history of injury or any other condition that significantly limits participant'sability to achieve moderate levels of physical activity;
13. excessive alcohol intake, acute or chronic;
14. currently pregnant, or breastfeeding, or not using a reliable method of birth controlfor the duration of the trial in all females with childbearing potential;
15. inability to take insulin degludec, liraglutide or metformin.