Efficacy and safety of insulin degludec in Japanese patients with type 1 and type 2 diabetes: 24‐week results from the observational study in routine clinical practice

Abstract

Aims/IntroductionInsulin degludec, a new long‐acting insulin analog, showed its better glycemic control and reduced risk of hypoglycemia. This is the first prospective observational study that evaluated the efficacy and safety of insulin degludec in routine clinical practice.Materials and MethodsJapanese patients with type 1 or type 2 diabetes mellitus receiving basal–bolus insulin therapy were switched their basal insulin to degludec, and prospectively observed over a 24‐week course. The Diabetes Therapy‐Related Quality of Life questionnaire was administered before and 12 weeks after switching.ResultsThe participants were 80 diabetes patients = (type 1, 44; type 2, 36). In the type 1 group, there was no difference in glycated hemoglobin levels between the pre‐switching and 24‐week measurements (from 62 to 62 mmol/mol, P = 0.768), whereas the daily insulin dose (per kg of bodyweight) decreased significantly (basal, from 0.25 to 0.20 U/kg, P < 0.001; bolus, from 0.40 to 0.37 U/kg, P = 0.001). In the type 2 group, glycated hemoglobin levels decreased after switching (from 60 to 58 mmol/mol, P = 0.028). In the type 1 group, the frequency of hypoglycemia decreased significantly after switching, but not significantly in the type 2 group. Patient satisfaction with the control of hypoglycemia tended to improve in the type 1 group.ConclusionsCompared with existing long‐acting insulin, degludec can maintain glycemic control at a lower insulin dose and frequency of hypoglycemia in type 1 diabetes, while it can improve glycemic control at an equal insulin dose in type 2 diabetes.

A 1‐year, prospective, observational study of Japanese outpatients with type 1 and type 2 diabetes switching from insulin glargine or detemir to insulin degludec in basal–bolus insulin therapy (Kumamoto Insulin Degludec Observational study)

“…There were significant reductions in basal, bolus and total insulin doses at 24 weeks after switching in the type 1 diabetes patients. The percentage changes in basal, bolus and total insulin doses after 24 weeks were approximately −20.0, −7.5 and −12.3%, respectively. In contrast, in the present study, the percentage changes in basal, bolus, and total insulin doses after 6 months in type 1 diabetes patients were −6.0, −3.7 and −4.6%, respectively.…”

“…After switching, the glycemic control was improved in all types of patients. In previous studies 7,9 , when participants were switched to IDeg, the basal insulin dose was adjusted, and dose reduction was greater in these reports than in the present study. Such greater dose reduction might be one of the reasons for unimproved glycemic control for participants that switched to IDeg in the previous studies 7,9 .…”

“…In previous studies 7,9 , when participants were switched to IDeg, the basal insulin dose was adjusted, and dose reduction was greater in these reports than in the present study. Such greater dose reduction might be one of the reasons for unimproved glycemic control for participants that switched to IDeg in the previous studies 7,9 . Therefore, our finding suggested that smaller basal insulin dose reduction might provide better glycemic control when patients with difficult glycemic control using IGlar or IDet were transferred to IDeg.…”

“…In a 2-year follow-up study, the basal and total insulin doses were lower in the IDeg group compared with the IGlar group 17 . Recently, Kobuke et al 9 reported that the switching from conventional long-acting basal insulin to IDeg in Japanese patients with type 2 diabetes was effective in lowering HbA1c at an equal insulin dose over 24 weeks, whereas improvement of HbA1c was not shown in patients with type 1 diabetes. There were significant reductions in basal, bolus and total insulin doses at 24 weeks after switching in the type 1 diabetes patients.…”

Glycemic Control in a Real-Life Setting in Patients with Type 2 Diabetes Treated with IDegLira at a Single Swiss Center

“…Several reports indicate that, when used individually in real-world populations, insulin degludec [15–18] and liraglutide [19, 20] each retain the benefits demonstrated in prior randomized controlled trials. This study adds to the body of real-world data by describing outcomes in Swiss patients with a long duration of T2D who were empirically selected for treatment with IDegLira.…”