Commentary to “Differential Effect of Hypoalbuminemia on Hypoglycemia on Type 2 Diabetes Patients Treated with Insulin Glargine 300 U/ml and Insulin Degludec” by Kawaguchi et al. Diabetes Therapy 2019

Pieber, Thomas R.; Bardtrum, Lars; Isendahl, Joakim; Wagner, Lily; Nishimura, Rimei

doi:10.1007/s13300-019-00755-3

Cited by 3 publications

(4 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To our knowledge, this is the second study where a greater reduction of HbA1c with Gla‐300 versus Deg‐100 was found. The difference in glycaemic control between Gla‐300 and Deg‐100 observed in the BRIGHT renal and elderly sub‐analysis has been attributed to BI characteristics, such as pharmacokinetics/pharmacodynamics or mechanism of action, possible differences in renal handling of insulin catabolism at lower eGFR levels, or concomitant treatments 22,23 . These findings arising from specific populations (i.e.…”

Section: Discussionmentioning

confidence: 99%

Treatment intensification following glucagon‐like peptide‐1 receptor agonists in type 2 diabetes: Comparative effectiveness analyses between different basal insulins. RESTORE‐G real‐world study

Napoli,

Nicolucci,

Larosa

et al. 2024

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

AimTo compare the effectiveness of different basal insulins (BI) prescribed as an add‐on to or switch from glucagon‐like peptide‐1 receptor agonist (GLP‐1 RA) therapy.Materials and MethodsRetrospective, real‐world data from electronic medical records of 32 Italian diabetes clinics were used, after propensity score adjustment, to compare effectiveness after 6 months of treatment with second‐ versus first‐generation BI (2BI vs. 1BI) or glargine 300 U/ml versus degludec 100 U/ml (Gla‐300 vs. Deg‐100), when added to (ADD‐ON) or in substitution of (SWITCH) GLP‐1 RA. Only comparisons, including a minimum of 100 patients per group, were performed to ensure adequate robustness of the analyses.ResultsIn the ADD‐ON cohort (N = 700), greater benefits of 2BI versus 1BI were found in glycated haemoglobin {HbA1c; estimated mean difference: −0.32% [95% confidence interval (CI) −0.62; −0.02]; p = .04} and fasting blood glucose [FBG; −20.73 mg/dl (95% CI −35.62; −5.84); p = .007]. In the SWITCH cohort (N = 2097), greater benefits of 2BI versus 1BI were found in HbA1c [−0.22% (95% CI −0.42; −0.02); p = .03], FBG [−10.15 mg/dl (95% CI −19.04; −1.26); p = .03], and body weight [−0.67 kg (95% CI −1.30; −0.04); p = .04]. In the SWITCH cohort starting 2BI (N = 688), marked differences in favour of Gla‐300 versus Deg‐100 were documented in HbA1c [−0.89% (95% CI −1.26; −0.52); p < .001] and FBG [−17.89 mg/dl (95% CI −32.45; −3.33); p = .02]. Using propensity score matching as a sensitivity analysis, the benefit on HbA1c was confirmed [−0.55% (95% CI –1.02; −0.08); p = .02]. BI titration was suboptimal in all examined cohorts.Conclusions2BI are a valuable option to intensify GLP‐1 RA therapy. Switching to Gla‐300 versus Deg‐100 was associated with greater HbA1c improvement.

show abstract

Section: Discussionmentioning

confidence: 99%

Treatment intensification following glucagon‐like peptide‐1 receptor agonists in type 2 diabetes: Comparative effectiveness analyses between different basal insulins. RESTORE‐G real‐world study

Napoli,

Nicolucci,

Larosa

et al. 2024

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“… 18 However, these data were limited by the short study period, lack of adjustment in starting insulin dose and heterogenous prior therapies in the study population. 19 Of note, neither BRIGHT nor CONCLUDE measured albumin levels. A post hoc analysis of the DEVOTE trial did not indicate an increased relative risk of hypoglycaemia for degludec versus glargine U100 in people with low albumin levels (<3.0 g/dL; n = 12) and did not demonstrate any albumin‐related safety signal concerning degludec.…”

Section: Figurementioning

confidence: 99%

“…A post hoc analysis of the DEVOTE trial did not indicate an increased relative risk of hypoglycaemia for degludec versus glargine U100 in people with low albumin levels (<3.0 g/dL; n = 12) and did not demonstrate any albumin‐related safety signal concerning degludec. 19 , 20 The hypothesis that degludec may have increased risk of hypoglycaemia in low albumin states appears improbable given that, at steady state, this insulin monomer occupies <0.01% of total albumin molecules, and the fraction occupied would remain negligible even in people with hypoalbuminaemia. 19 Furthermore, degludec, like any insulin, is individually titrated to the patient's glycaemic response.…”

Section: Figurementioning

confidence: 99%

“… 19 , 20 The hypothesis that degludec may have increased risk of hypoglycaemia in low albumin states appears improbable given that, at steady state, this insulin monomer occupies <0.01% of total albumin molecules, and the fraction occupied would remain negligible even in people with hypoalbuminaemia. 19 Furthermore, degludec, like any insulin, is individually titrated to the patient's glycaemic response. Therefore, for the free degludec fraction to increase significantly in an individual, there would need to be extreme acute changes in that person's albumin concentration.…”

Section: Figurementioning

confidence: 99%

See 1 more Smart Citation

Impact of kidney function on the safety and efficacy of insulin degludec versus insulin glargine U300 in people with type 2 diabetes: A post hoc analysis of the CONCLUDE trial

Pieber

Bajaj

Heller

et al. 2021

Diabetes Obesity Metabolism

Self Cite

View full text Add to dashboard Cite

Differential glycaemic control with basal insulin glargine 300 U/mL versus degludec 100 U/mL according to kidney function in type 2 diabetes: A subanalysis from the BRIGHT trial

Haluzı́k

Cheng

Müller‐Wieland

et al. 2020

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

Aims Chronic kidney disease (CKD) challenges diabetes management and is associated with increased cardiovascular morbidity and mortality. We examined whether clinical outcomes with insulin glargine 300 U/mL (Gla‐300) and insulin degludec 100 U/mL (IDeg‐100) are affected by renal function in a prespecified subgroup analysis from the BRIGHT trial. Materials and methods BRIGHT (NCT02738151) was a multicentre, open‐label, randomized, active‐controlled, two‐arm, parallel‐group, 24‐week study in insulin‐naïve uncontrolled type 2 diabetes (T2D). Participants were randomized 1:1 to evening Gla‐300 (n = 466) or IDeg‐100 (n = 463) and stratified based on baseline estimated glomerular filtration rate (eGFR) for this analysis. Results Heterogeneity of treatment effect across renal function subgroups was observed ( P = .02), reflecting a greater mean glycated haemoglobin (HbA1c) reduction from baseline to week 24 with Gla‐300 versus IDeg‐100 in the eGFR <60 mL/min/1.73 m 2 subgroup (least squares mean difference: −0.43% [95% confidence interval: −0.74% to −0.12%]), while there were no differences in hypoglycaemia incidence or rates over 24 weeks in that subgroup. HbA1c reductions were similar between treatments in the other eGFR subgroups. However, heterogeneity was observed for annualized rates of anytime (24 hours) or nocturnal (00:00‐05:59 hours) confirmed hypoglycaemia (≤70 mg/dL [≤3.9 mmol/L]) over 24 weeks showing less hypoglycaemia with Gla‐300 versus IDeg‐100 in the ≥90 mL/min/1.73 m 2 . Conclusions Kidney function seems to affect the glucose‐lowering effects of Gla‐300 versus IDeg‐100 in insulin‐naïve T2D. Greater HbA1c reductions with Gla‐300 without increase in hypoglycaemia risk, were observed in patients with eGFR <60 mL/min/1.73 m 2 .

show abstract

Commentary to “Differential Effect of Hypoalbuminemia on Hypoglycemia on Type 2 Diabetes Patients Treated with Insulin Glargine 300 U/ml and Insulin Degludec” by Kawaguchi et al. Diabetes Therapy 2019

Cited by 3 publications

References 7 publications

Treatment intensification following glucagon‐like peptide‐1 receptor agonists in type 2 diabetes: Comparative effectiveness analyses between different basal insulins. RESTORE‐G real‐world study

Treatment intensification following glucagon‐like peptide‐1 receptor agonists in type 2 diabetes: Comparative effectiveness analyses between different basal insulins. RESTORE‐G real‐world study

Impact of kidney function on the safety and efficacy of insulin degludec versus insulin glargine U300 in people with type 2 diabetes: A post hoc analysis of the CONCLUDE trial

Differential glycaemic control with basal insulin glargine 300 U/mL versus degludec 100 U/mL according to kidney function in type 2 diabetes: A subanalysis from the BRIGHT trial

Contact Info

Product

Resources

About