Efficacy of switching from insulin glargine to insulin degludec in patients with type 1 diabetes: a 16-week retrospective study

Abstract

We retrospectively investigated the effect of switching from insulin glargine (IGlar) to insulin degludec (IDeg) on glycemic control in Japanese patients with type 1 diabetes mellitus. We also evaluated the dose of IDeg, and assessed weight gain and the risk of hypoglycemia after switching. Forty-five patients with type 1 diabetes were switched from IGlar (once daily or twice daily) to IDeg (once daily) during routine medical care. Data were collected for 16 weeks after switching from IGlar to IDeg. The mean HbA1c (%) in weeks 4, 8, 12, and 16 was lower than it was in week 0 (8.0 ± 1.0, 8.0 ± 1.4, 7.9 ± 1.1, 7.6 ± 1.0 vs. 8.3 ± 1.3 %, p \ 0.01). The total basal insulin dose (TBD) was significantly lower after 16 weeks of IDeg as compared to IGlar treatment (0.30 ± 0.12 vs. 0.24 ± 0.11 U/kg/day, p = 0.001). In the twice-daily IGlar group, TBD showed a significant decrease from 0.33 ± 0.12 to 0.26 ± 0.11 U/kg/day (p \ 0.001) after switching to IDeg. In the once-daily IGlar group, TBD showed a slight but not significant decrease from 0.23 ± 0.08 to 0.20 ± 0.09 U/kg/day (p = 0.97). Hypoglycemic episodes were transiently increased, but the change was not significant. The blood glucose fluctuation was evaluated from self-monitoring data and the coefficient of variation (CV) was calculated. The CV showed only a minimal change from 48.3 ± 17.1 to 48.6 ± 14.2 % at 12 weeks after switching to IDeg (p = 0.73). In conclusion, once-daily IDeg improved glycemic control in patients with type 1 diabetes compared to the control achieved with IGlar, without increasing the risk of hypoglycemia. When switching from IGlar (especially twice daily), it is recommended that the initial dose of IDeg should be reduced in order to decrease the risk of hypoglycemia.

Insulin Doses Requirements in Patients with Type 1 Diabetes Using Glargine U300 or Degludec in Routine Clinical Practice

“…Therefore, approximately half (40%-60%) of total daily insulin doses in patients with T1D using multiple daily injections is given as basal insulin, dependent on body weight and insulin sensitivity, and the rest is divided into meal-related doses, mainly based on carbohydrate content 38 39. In our population, daily basal insulin doses were 58% of the daily total doses, similarly to other national studies in T1D reporting that daily basal doses ranged 55%-63% of daily total insulin doses and could be explained, in part, for Mediterranean diet and lifestyle followed by the Spanish populations,20 40 in contrast with studies in other countries in patients with T1D where daily basal insulin requirements usually are ≤50% 21 27 31 39…”

“…In RWS with patients with T1D, switching to IDeg from IGla-100 or detemir is associated with a 12%-13% reduction of both basal and prandial daily insulin doses,18 21 28 mainly in patients who were previously on two injections of basal insulin. However, other studies in real-life conditions informed that IDeg doses in patients with T1D transferred from IGla-100 once-daily were equivalent 25–27 31…”

“…The second-generation long-acting insulin analogs, glargine U300 UI/mL (IGla-300) and degludec (IDeg), were introduced in 2015 and have shown, in randomized controlled trials (RCTs), an increased stability, which translates to an increased flexibility in timing of administration12 13 and reduced risk of hypoglycemia compared with glargine U100 UI/mL insulin (IGla-100),14 15 results that have been reproduced in several real-world studies (RWS),16–21 although others have reported no differences in hypoglycemia between first-generation and second-generation basal analogs 22–25. Otherwise, a number of RCTs and RWS have reported higher daily insulin doses requirements (DIDR) with IGla-30012 15 20 and lower with IDeg,13 14 18 21 compared with IGla-100, although some studies failed to detect these difference 17 23–31…”

The Clinical Impact of Switching Basal Insulin to Insulin Degludec in Patients With Diabetes in Saudi Arabia: A Retrospective One-Group Pretest-Posttest Design Study

“…However, the same study reported that insulin glargine (U300) users had higher insulin dose requirements when compared to insulin degludec (U100) users [ 20 ]. A Japanese study revealed that switching to insulin degludec resulted in better glycemic control in 16 weeks with lower insulin dosing requirements [ 21 ]. Similarly, real-world data reported a significant reduction in HbA1c, which was achieved after switching to insulin degludec, irrespective of the type of diabetes and the type of prior long-acting insulin, and with lower insulin requirements [ 22 ].…”

Reduced Rates of Hypoglycemia in Type 1 or Type 2 Diabetes After Switching to Insulin Degludec: Results from the Italian Cohort of the ReFLeCT Study

“…In recent years, the importance of complementing clinical trial results with real-world evidence has been widely recognized, with the aim of assessing the generalizability of results from RCTs to wider, less selected populations [11,12]. Several real-world studies have evaluated the effectiveness and safety of insulin degludec [13][14][15][16][17][18][19][20][21][22][23][24] in routine clinical practice. However, none of these studies have prospectively collected information on hypoglycemic events.…”