Comparison of Second-Generation Basal Insulin Analogs: A Review of the Evidence from Continuous Glucose Monitoring

Abstract

Many people with insulin-treated diabetes continue to experience inadequate glycemic control and a high incidence of hypoglycemic events, despite improvements in therapeutic strategies. While glycated hemoglobin (HbA 1c) is currently recognized as the gold-standard for assessing glycemic control, the measure reflects mean blood glucose levels over a period of time, does not inform on acute glycemic deviations, and can be unreliable in certain populations. Continuous glucose monitoring (CGM) facilitates the acquisition of blood glucose data around the clock and, importantly, predicts and/or captures acute hyper-and hypoglycemic episodes. In light of the recent publication of the Time in Range (TIR) International Consensus Group report on key CGM metrics, we performed a review of current CGM evidence for second-generation basal insulins in both people with type 1 and type 2 diabetes. The identified studies highlight the varied CGM-related metrics used to assess basal insulins, which complicate comparisons. Furthermore, all studies had small sample sizes and typically were of short duration, which may account for the lack of statistically significant between-treatment differences observed. Differences were seen in the titration approaches used and the settings in which participants were observed. These results highlight the need for further studies of secondgeneration basal insulin analogs that are designed to capture the standard metrics proposed by the TIR consensus group, with additional consideration given to sample size and study duration.

Continuous glucose monitoring‐based time‐in‐range using insulin glargine 300 units/ml versus insulin degludec 100 units/ml in type 1 diabetes: The head‐to‐head randomized controlled InRange trial

“…The use of CGM has allowed the generation of clinical goals such as the percentage of time within the target glucose range (i.e. TIR), time above range (TAR) and time below range (TBR), and glucose variability metrics such as glucose coefficient of variation (CV), which add to and complement traditional metrics such as HbA1c 18,19 . Furthermore, standard blood glucose monitoring can underestimate hypoglycaemia, 20‐22 with one study in type 2 diabetes reporting a 3‐8–fold increase in the frequency of events with CGM 20 .…”

“…TIR), time above range (TAR) and time below range (TBR), and glucose variability metrics such as glucose coefficient of variation (CV), which add to and complement traditional metrics such as HbA1c. 18 , 19 Furthermore, standard blood glucose monitoring can underestimate hypoglycaemia, 20 , 21 , 22 with one study in type 2 diabetes reporting a 3‐8–fold increase in the frequency of events with CGM. 20 Such a differential is probable to be magnified at night when some events will be undetected by the person with diabetes.…”

Basal Insulinotherapy in Patients Living with Diabetes in France: The EF-BI Study

“…If Gla-300 and IDeg seem to have similar glycemic control improvements with relatively low hypoglycemia risk [ 4 , 5 ], further trials of direct comparisons of 2BI with first-generation basal insulins (1BI) [ 6 ] are probably needed. The use of real-life databases may answer some of the questions that arise in this field concerning, for example, the maintenance over time of treatment, or the comparative frequency of the main acute events linked to diabetes treatment (i.e.…”

Insulin glargine 300 U/ml versus insulin degludec 100 U/ml improves nocturnal glycaemic control and variability in type 1 diabetes under routine clinical practice: A glucodensities‐based post hoc analysis of the OneCare study

“…The generalized use of continuous glucose monitoring (CGM) is also improving glycaemic control 9 . This technique is said to become the gold standard for clinical research in T1D, 10 particularly for comparison between new insulins 11 . However, from a mathematical point of view, the analysis of CGM data is challenging in any setting, and therefore, several new CGM‐derived metrics were proposed recently in the literature.…”