Switching “Real-World” Diabetes Patients to Degludec from Other Basal Insulins Provides Different Clinical Benefits According to Their Baseline Glycemic Control

Abstract

IntroductionThe stable, ultra-long duration of action of insulin degludec (degludec) minimizes fluctuations in glucose-lowering activity over the daily (24-h) dosing period, and comparative studies with other basal insulins suggest that these properties translate into a lower risk of hypoglycemia at equivalent levels of glycemic control. Results from the real-world European multicenter, retrospective chart review study of 2550 patients with type 1 and type 2 diabetes (T1D and T2D) in routine clinical care EU-TREAT (NCT02662114) showed that patients benefited from improved glycemic control and significantly reduced rates of hypoglycemia following a switch to degludec.MethodsIn this post hoc analysis, EU-TREAT patients were stratified into good (≤ 7.5% HbA1c), intermediate (> 7.5 to ≤ 8.5% HbA1c), and poor (> 8.5% HbA1c) glycemic control at baseline to investigate the possibility of differential benefits, either improved control or reduced risk of hypoglycemia, whichever the need. Changes in HbA1c, overall hypoglycemia, and total insulin dose from baseline to 6 and 12 months follow-up were assessed for each group.ResultsFor both T1D and T2D patients, those in good initial control experienced significant reductions in rates of hypoglycemia and total insulin dose following the switch, without compromising control. Those in poor initial control achieved significant improvements in HbA1c with no change in rates of hypoglycemia or total insulin dose.ConclusionThis analysis expands the findings of EU-TREAT by showing differential changes in the clinical endpoints depending on particular need. It introduces the possibility that the differential benefits of degludec could address two of the renowned clinical challenges faced when treating diabetes: improving glycemic control for optimal management of T1D and titrating insulin dose in T2D, both without fear of increased hypoglycemia.Trial RegistrationClinicalTrials.gov, NCT02662114.FundingNovo Nordisk A/S.Electronic supplementary materialThe online version of this article (10.1007/s12325-019-00916-7) contains supplementary material, which is available to authorized users.

Effectiveness and Safety of Insulin Glargine 300 U/ml in Comparison with Insulin Degludec 100 U/ml Evaluated with Continuous Glucose Monitoring in Adults with Type 1 Diabetes and Suboptimal Glycemic Control in Routine Clinical Practice: The OneCARE Study

“…This creates a reservoir from which monomers are released continuously and slowly to be finally absorbed into the blood flow. It has been demonstrated to have a stable pharmacodynamic profile, which leads to lower fluctuations in glucose levels as also observed in clinical trials [16] and real-world studies [17,18].…”

Switching Patients with Type 1 Diabetes to Insulin Degludec from Other Basal Insulins: Real-World Data of Effectiveness and Safety

“…Real-world data are also important in providing relevant information on the effectiveness and safety of any new drug when used in routine clinical practice [8,9]. However, the impact of IDeg on metabolic control, hypoglycemia and body weight when used in real-world patient populations has seldom been investigated [10,11]. Therefore, additional realworld data are needed in order to support the effectiveness and safety of switching from other basal insulins to IDeg in patients with T1DM.…”