Efficacy and Safety of Insulin Degludec for Hyperglycemia Management in Noncritical Hospitalized Patients with Diabetes: An Observational Study

Abstract

IntroductionTo assess the efficacy and safety of insulin degludec administered in a basal-bolus regimen according to the GesTIO protocol in noncritical hospitalized patients with T1DM and T2DM.MethodsMean blood glucose levels (BG) and their standard deviations (SD) at admission vs. discharge were compared in 52 subjects (48.1% ≥75 years) managed through a basal-bolus scheme including degludec. The percentages of patients with BG at target (140–180 mg/dl) or below at discharge and the incidence rate (and the 95% confidence interval for it) of hypoglycemia were assessed.ResultsFrom admission to discharge, fasting BG decreased from 237 to 153 mg/dl (p < 0.0001) and SD dropped from 125 to 38 mg/dl (p < 0.0001); average BG decreased from 189 to 145 mg/dl (SD dropped from 57 to 32 mg/dl). At discharge, 28.9% had BG at target, while 50.0% had lower levels (average 119.0 ± 14.4 mg/dl). The incidence rate of hypoglycemia was 0.07 (0.05; 0.11) episodes per person-day; 1 out of 27 episodes occurred during the night.ConclusionsDegludec in hospitalized, mainly elderly patients is effective and minimizes glucose variability and nocturnal hypoglycemia.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-017-0271-6) contains supplementary material, which is available to authorized users.

Considerations for Insulin-Treated Type 2 Diabetes Patients During Hospitalization: A Narrative Review of What We Need to Know in the Age of Second-Generation Basal Insulin Analogs

“…No symptomatic or severe hypoglycemic episodes occurred during the hospital stay, and there was evidence of a reduction in within-day glycemic variability (as measured by the coefficient of variation of glycemia every 6 h) [ 52 ]. Similar results were observed in an observational study of 52 non-critical patients with diabetes who received degludec as part of a basal–bolus regimen while hospitalized [ 53 ]. It is not possible to draw conclusions on the effect and safety of degludec-based regimens in hospitalized patients based on the current data available; it remains to be seen whether the outcomes described in these small observational studies will also be observed in large, randomized trials.…”

Efficacy and safety of insulin degludec U100 and insulin glargine U100 in combination with meal-time bolus insulin in hospitalized patients with type 2 diabetes: an open-label, randomized controlled study

“…In a prospective observational study by Yamamoto et al, on in-patients with type 1 diabetes, CGM revealed that MAGE significantly decreased when switching from IGla to IDeg [35]. There have not been many similar reports for type 2 diabetes [38], and this is the first randomized clinical trial report, comparing the efficacy and safety of IGla and IDeg over a short term in patients with type 2 diabetes.…”