Favorable Glycemic Control with Once-Daily Insulin Degludec/Insulin Aspart after Changing from Basal Insulin in Adults with Type 2 Diabetes

Abstract

BackgroundConflicting results have been reported on the efficacy of insulin degludec/insulin aspart (IDegAsp) compared to basal insulin in type 2 diabetes. We investigated the effects of changing basal insulin to IDegAsp on glycemic control and sought to identify factors related to those effects.MethodsIn this retrospective study of patients from three referral hospitals, patients with type 2 diabetes using basal insulin with hemoglobin A1c (HbA1c) levels less than 11.0% were enrolled. Basal insulin was replaced with IDegAsp, and data were analyzed from 3 months before to 3 months after the replacement.ResultsEighty patients were recruited (52.5% male; mean age, 67.0±9.8 years; mean duration of diabetes, 18.9±8.5 years; mean HbA1c, 8.7%±1.0%). HbA1c levels increased during 3 months of basal insulin use, but significantly decreased after changing to IDegAsp (8.28%±1.10%, P=0.0001). The reduction was significant at 6 months in 35 patients whose longer-term data were available. Patients with a measured fasting plasma glucose (m-FPG) lower than their predicted FPG (p-FPG) by regression from HbA1c showed a significant HbA1c reduction caused by the change to IDegAsp, even without a significantly increased insulin dose. However, patients whose m-FPG was higher than their p-FPG did not experience a significant HbA1c reduction, despite a significantly increased insulin dose. Furthermore, the HbA1c reduction caused by IDegAsp was significant in patients with low fasting C-peptide levels and high insulin doses.ConclusionWe observed a significant glucose-lowering effect by replacing basal insulin with IDegAsp, especially in patients with a lower m-FPG than p-FPG.

Efficacy and Safety of Insulin Degludec/Insulin Aspart Compared with a Conventional Premixed Insulin or Basal Insulin: A Meta-Analysis

“…The literature search yielded 921 potentially relevant articles (PubMed 154, EMBASE 295, and Cochrane Library 472), of which 719 were screened for title and abstract after excluding 202 duplicate articles. Thereafter, 674 articles that did not meet the inclusion criteria were excluded, and the remaining 45 studies were evaluated for eligibility by performing a full-text review; finally, 17 studies [ 10 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ] with 3831 participants were included in this meta-analysis ( Figure 1 ). The effect on glycemic control and the risk of hypoglycemia development with those on the twice-daily IDegAsp regimen were reported in eight studies [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ], while those on the once-daily regimen were reported in nine studies [ 10 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ].…”

“…We classified one RCT with a serious risk of bias as we used the data to only determine the switch from once-daily basal insulin to once-daily IDegAsp [ 23 ]. Three trials with a one-group pretest–post-test design demonstrated a serious risk of bias [ 13 , 14 , 21 ].…”

Fear of hypoglycemia in adults with diabetes mellitus switching to treatment with IDegAsp co-formulation to examine real-world setting: an observational study (The HATICE study)

“…IDegAsp serves as a simple and adaptive treatment option requiring only a single injection that can reveal a better alternative to achieve a higher standards of patients' lifestyle and QoL in comparison with more complex alternatives, with a lower frequency of daily injections (in comparison with the basal-bolus and premixed regimens), which is more likely to be perceived and recognized as less burdensome by patients [7,21,22]. By means of switching to IDegAsp in our study, the median of daily insulin administration frequency applied by the participants decreased from 4 to 2.…”

Letter: Favorable Glycemic Control with Once-Daily Insulin Degludec/Insulin Aspart after Changing from Basal Insulin in Adults with Type 2 Diabetes (Endocrinol Metab 2019; 34:382-9, Han Na Jang et al.)

“…I read with interest the article by Jang et al [1], entitled "Favorable glycemic control with once-daily insulin degludec/insulin aspart after changing from basal insulin in adults with type 2 diabetes." In the absence of high-level clinical evidence for insulin users in Korea, the study provided new insights for clinical researchers studying diabetes mellitus (DM).…”