Insulin degludec results in lower rates of nocturnal hypoglycaemia and fasting plasma glucose vs. insulin glargine: A meta-analysis of seven clinical trials

Russell‐Jones, David; Gall, Mari-Anne; Niemeyer, Marcus; Diamant, Michaëla; Prato, Stefano Del

doi:10.1016/j.numecd.2015.06.005

Cited by 58 publications

(34 citation statements)

References 29 publications

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“…Two new second‐generation BIs, insulin glargine 300 units/mL (Gla‐300) and insulin degludec (IDeg), with smooth action profiles and reduced risk of hypoglycaemia, have been approved recently . In the USA, Gla‐300 became available in 2015.…”

Section: Introductionmentioning

confidence: 99%

Real‐world evidence concerning clinical and economic outcomes of switching to insulin glargine 300 units/mL vs other basal insulins in patients with type 2 diabetes using basal insulin

Zhou

Berhanu

et al. 2018

Diabetes Obesity Metabolism

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This retrospective cohort study compared real‐world clinical and healthcare‐resource utilization (HCRU) data in patients with type 2 diabetes using basal insulin (BI) who switched to insulin glargine 300 units/mL (Gla‐300) or another BI. Data from the Predictive Health Intelligence Environment database 12 months before (baseline) and 6 months after (follow‐up) the switch date (index date, March 1, 2015 to May 31, 2016) included glycated haemoglobin A1c (HbA1c), hypoglycaemia, HCRU and associated costs. Baseline characteristics were balanced using propensity score matching. Change in HbA1c from baseline was similar in both matched cohorts (n = 1819 in each). Hypoglycaemia incidence and adjusted event rate were significantly lower with Gla‐300. Patients switching to Gla‐300 had a significantly lower incidence of HCRU related to hypoglycaemia. All‐cause and diabetes‐related hospitalization and emergency‐department HCRU were also favourable for Gla‐300. Lower HCRU translated to lower costs in patients using Gla‐300. In this real‐world study, switching to Gla‐300 reduced the risk of hypoglycaemia in patients with type 2 diabetes when compared with those switching to another BI, resulting in less HCRU and potential savings of associated costs.

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Section: Introductionmentioning

confidence: 99%

Real‐world evidence concerning clinical and economic outcomes of switching to insulin glargine 300 units/mL vs other basal insulins in patients with type 2 diabetes using basal insulin

Zhou

Berhanu

et al. 2018

Diabetes Obesity Metabolism

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“…Basal insulins provide effective reduction of FPG levels, but increases in PPG may be inadequately controlled, and there is a risk of hypoglycemia and weight gain compared with OAD therapy alone 3,4. Long-acting basal analog insulins such as insulin glargine 100 units/mL have proved to be safe and efficacious in long-term randomized trials and in high-quality meta-analyses,5,6 while newer basal analog insulins, such as insulin glargine 300 units/mL and ultra-long-acting insulin degludec, may have further advantages in terms of reducing weight gain and hypoglycemia 7,8…”

Section: Introductionmentioning

confidence: 99%

Real-world medication persistence and outcomes associated with basal insulin and glucagon-like peptide 1 receptor agonist free-dose combination therapy in patients with type 2 diabetes in the US

Lin¹,

Lingohr-Smith²,

Fan³

2016

CEOR

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BackgroundFree-dose combination treatment with basal insulin and short-acting glucagon-like peptide-1 receptor agonists (GLP-1 RAs) reduces hyperglycemia via complementary targeting of fasting and postprandial blood glucose levels, however, in the real world, due to injection burden and clinical inertia, the full efficacy may not be able to translate into clinical and economic benefits.ObjectiveThe aim of the study was to evaluate treatment persistence and associated outcomes in patients with type 2 diabetes (T2D) treated with a GLP-1 RA in free-dose combination with basal insulin.MethodsClaims data were extracted on US adults with T2D with ≥1 prescription claim for both a GLP-1 RA and a basal insulin from July 1, 2008 to June 30, 2013, and continuous health plan coverage for 6 months prior to (baseline) and 12 months after the index date (follow-up period). Outcomes analyzed for patients stratified by treatment persistence included glycemic control, hypoglycemia, and health care costs and resource utilization. Multivariate analyses were used to examine factors associated with persistence or hypoglycemia.ResultsThe analysis included 7,320 patients, of whom 16.9% were persistent with free-dose combination treatment. The median time to treatment discontinuation was 133 days. Compared with nonpersistent patients, persistent patients had greater glycated hemoglobin A1c (A1C) reductions (−0.80% vs −0.42%; P=0.032), were more likely to achieve A1C <7.0% (39% vs 22%; P<0.001), and were less likely to experience hypoglycemia (9.5% vs 6.8%; P=0.002). Persistent patients also had significantly fewer hospitalizations and shorter hospital stays. While prescription costs were significantly higher (all-cause: $14,691 vs $10,791; P<0.001; diabetes-related: $8,142 vs $5,124; P<0.001), total medical charges were significantly lower (all-cause: $28,405 vs $40,292; P=0.001; diabetes-related: $11,114 vs $15,203; P=0.003) for persistent patients compared with nonpersistent patients.ConclusionThis retrospective claims study of US patients with T2D showed that, although persistence with concurrent GLP-1 RA and basal insulin treatment is low, improved treatment persistence is associated with greater A1C reductions and lower total medical charges.

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“…This reluctance to intensify insulin regimens may be due to factors including fear of hypoglycaemia, weight gain, burdensome regimens, or cost . In this regard, currently available second‐generation BIs have sought to reduce hypoglycaemia risk without compromising A1C reduction; however, it remains to be determined whether these novel insulins (eg, insulin glargine 300 units/mL and insulin degludec) will overcome such reluctance to intensify insulin therapy.…”

Section: Discussionmentioning

confidence: 99%

Clinical implications of prolonged hyperglycaemia before basal insulin initiation in type 2 diabetes patients: An electronic medical record database analysis

Raccah

Guerci

Ajmera

et al. 2019

Endocrino Diabet & Metabol

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Summary Aims To assess the effect of duration of hyperglycaemia before basal insulin (BI) initiation on clinical outcomes in type 2 diabetes (T2D). Materials and methods Patients with T2D who initiated BI during 2009‐2013, had continuous enrolment for ≥2 years preceding and ≥1 year following BI initiation (“index date”), and had ≥1 glycated haemoglobin (A1C) measure not at target (ie, ≥7.0%) within 6 months preindex date were included in the study. Patients were stratified by preindex‐date duration of A1C ≥7.0%. Longitudinal A1C, weight, BMI, and diabetes medication were compared between cohorts for up to 15‐month follow‐up. Results Of 37 053 patients who initiated BI, 40.7%, 15.3%, 16.0%, and 28.0%, respectively, had uncontrolled A1C for <6, 6‐<12, 12‐<18 and 18‐24 months preindex date. Baseline characteristics were similar between cohorts. Baseline A1C values were similar across cohorts (9.2%‐9.6%). Mean follow‐up A1C values were higher with longer preindex‐date duration of uncontrolled A1C (8.0 ± 1.7%, 8.2 ± 1.6%, 8.5 ± 1.7%, and 8.6 ± 1.7% for <6, 6‐<12, 12‐<18, and 18‐24 months); attainment of A1C <7.0% worsened with increasing preindex‐date duration of A1C ≥7.0% (29.6%, 20.0%, 14.6%, and 11.5% for <6, 6‐<12, 12‐<18, and 18‐24 months). Conclusions These data suggest that longer duration of uncontrolled A1C before BI initiation increases the risk of not reaching glycaemic targets. However, target attainment was poor in all cohorts, highlighting inadequate glycaemic control as an important unmet need in US patients with T2D.

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Insulin degludec results in lower rates of nocturnal hypoglycaemia and fasting plasma glucose vs. insulin glargine: A meta-analysis of seven clinical trials

Abstract: This analysis shows that the lower rate of nocturnal confirmed hypoglycaemia seen with IDeg relative to IGlar is accompanied by a reduced mean FPG, in particular in patients with T2D.

Cited by 58 publications

References 29 publications

Real‐world evidence concerning clinical and economic outcomes of switching to insulin glargine 300 units/mL vs other basal insulins in patients with type 2 diabetes using basal insulin

Real‐world evidence concerning clinical and economic outcomes of switching to insulin glargine 300 units/mL vs other basal insulins in patients with type 2 diabetes using basal insulin

Real-world medication persistence and outcomes associated with basal insulin and glucagon-like peptide 1 receptor agonist free-dose combination therapy in patients with type 2 diabetes in the US

Clinical implications of prolonged hyperglycaemia before basal insulin initiation in type 2 diabetes patients: An electronic medical record database analysis

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