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Sponsor: Sanofi
Conditions: Type 2 Diabetes Mellitus
Interventions: Insulin glargine/lixisenatide fixed ratio combination, liraglutide, exenatide, exenatide extended-release, albiglutide
Countries: United States, Canada, Estonia, Germany, Israel, Italy, Romania, Slovakia
Primary Objective: To demonstrate the superiority of the insulin glargine/lixisenatide fixed ratio combination (FRC) versus GLP-1 receptor agonist (GLP-1 RA) in hemoglobin A1c (HbA1c) change. Secondary Objectives: To compare the overall efficacy and safety of the insulin glargine/lixisenatide FRC to GLP-1 RA on top of metformin (with or without pioglitazone, with or without sodium-glucose co-transporter 2 \[SGLT2\] inhibitor) in participants with type 2 diabetes. To evaluate safety, efficacy and other endpoints of FRC up to the end of the extension period.
Sex: ALL
Age: 18 Years to —
Healthy volunteers: No
Study type: INTERVENTIONAL
Inclusion criteria : * Participants with type 2 diabetes mellitus diagnosed at least 1 year prior to screening visit. * Participants who were treated with one of the following GLP-1 receptor agonists for at least 4 months prior to screening visit 1 (V1), and with stable dose for at least 3 months prior to screening visit (V1): * Liraglutide (Victoza®) 1.8 milligram (mg) QD or 1.2 mg QD, if the 1.8 mg QD dose was not well tolerated according to the Investigator's judgment or * Exenatide (Byetta®) 10 microgram (µg) BID or of 5 µg BID, if 10 µg BID dose was not well tolerated according to the Investigator's judgment in combination with metformin (daily dose greater than equal to \[\>=\] 1500 mg/day or maximum tolerated dose \[MTD\]), with or without pioglitazone, with or without SGLT2 inhibitor, all at stable dose for at least 3 months prior to screening. or Participants who were treated with stable dose of one of the following GLP-1 receptor agonists for at least 6 months prior to screening visit (V1): * Exenatide extended-release (Bydureon®) 2 mg once weekly (QW), if well tolerated according to Investigator's judgment, * Albiglutide (Tanzeum®) 50 mg QW or 30 mg QW, if 50 mg QW was not well tolerated according to Investigator's judgment, * Dulaglutide (Trulicity®) 1.5 mg QW or 0.75 mg QW, if 1.5 mg QW was not well tolerated according to Investigator's judgment in combination with metformin (daily dose ≥1500 mg/day or MTD), with or without pioglitazone, with or without SGLT2 inhibitor, all at stable dose for at least 3 months prior to screening; -Signed written informed consent. Exclusion criteria: * At screening visit, age \<18. * Screening HbA1c \<7% and \>9%. * Pregnancy or lactation, women of childbearing potential with no effective contraceptive method. * Any use of antidiabetic drugs within 3 months prior to the screening visit other than those described in the inclusion criteria. * Previous treatment with insulin in the year prior to screening visit (note: short-term treatment with insulin \[\<=10 days\] due to intercurrent illness including gestational diabetes was allowed at the discretion of the study physician). * Laboratory findings at the time of screening, including: * Fasting plasma glucose (FPG) \>250 mg/dL (13.9 millimoles per litre \[mmol/L\]), * Amylase and/or lipase \>3 times the upper limit of the normal laboratory range (ULN), * Alanine transaminase or aspartate transaminase \>3 ULN, * Calcitonin \>=20 pg/mL (5.9 pmol/L), * Positive pregnancy test. * Participant who had renal function impairment with estimated glomerular filtration rate \<30mL/min/1.73m\^2 (using the Modification of Diet in Renal Disease formula) or end-stage renal disease. * Contraindication to use of insulin glargine, or lixisenatide or GLP-1 receptor agonist (Victoza®, Byetta®, Bydureon®, Tanzeum® or Trulicity®) according to local labeling. * Any contraindication to metformin or pioglitazone or SGLT2 inhibitor use, according to local labeling. * History of hypersensitivity to insulin glargine, or to any of the excipients. * History of allergic reaction to any GLP-1 receptor agonist or to meta-cresol. * Personal or immediate family history of medullary thyroid cancer (MTC) or genetic condition that predisposes to MTC (eg, multiple endocrine neoplasia type 2 syndromes). * History of pancreatitis (unless pancreatitis was related to gallstones and cholecystectomy was already performed), chronic pancreatitis, pancreatitis during a previous treatment with incretin therapies, pancreatectomy. * Body mass index \<=20 or \>40 kg/m\^2. Exclusion criteria for the extension period: * Participants in the FRC arm with a rescue therapy and HbA1c \>8% at week 22. * Participants in the FRC arm who discontinued prematurely from FRC treatment before week 26. * Participants in the GLP-1 RA treatment arm after randomization. The above information is not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.
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