Achieving Glycaemic Control with Concentrated Insulin in Patients with Type 2 Diabetes

Abstract

The recent introduction of the second generation long-acting analogue insulins degludec and insulin glargine U300 have increased the choice of basal insulin therapy for patients with type 2 diabetes. The pharmacokinetic and pharmacodynamic properties of these insulins result in a flatter profile which lasts over 24 hours and provides an increased window of administration of six hours once daily. Large scale multicentre randomised clinical trial programmes (BEGIN for degludec U100 and U200 and EDITION for glargine U300) evaluating these insulin therapies against glargine U100 have demonstrated that they are either non-inferior or superior for glycaemic efficacy and safety but less likely to result in severe or nocturnal hypoglycaemia than glargine U100. The disposable pen devices for these insulins have been designed with patient satisfaction and convenience in mind. No concerns have arisen with adverse events with insulin analogues or cardiovascular safety from the ORIGIN and DEVOTE trials. As they demonstrate equivalent glycaemic efficacy to other basal insulins, they should be considered more in selected patient groups including those with recurrent or increased risk of hypoglycaemia, especially severe or nocturnal episodes, in the elderly or those living alone, and in patients with multiple co-morbidities such as cardiovascular or renal disease. Key Points • Second generation basal insulin analogues have demonstrated equivalent glycaemic efficacy to earlier basal insulin therapies but may result in lower risk of hypoglycaemia. • Selected patient groups at increased risk of hypoglycaemia such as elderly, those living alone or with multiple co-morbidities including cardiovascular or renal disease may be considered for treatment with insulin degludec or glargine U300.

Effectiveness and safety of insulin glargine Gla-300 in insulin-naïve type 2 diabetes subjects in a real-life setting—the GOAL_RO trial

“…Gla-300 is a second-generation basal insulin analog approved for clinical use since 2015 (12). It has the same molecular structure and metabolism but is 3× more concentrated in comparison with insulin Gla-100 (13).…”

Association between MIC-1 and Type 2 Diabetes: A Combined Analysis

“…Overweight and obesity have been regarded as the main risk factors contributing to T2DM [4]. Approximately 50% of obese subjects will develop into T2DM [5]. Thus, pathway targeting energy metabolism may provide useful diagnosis and treatment information for T2DM [6].…”

New Insulins, Biosimilars, and Insulin Therapy

“…Comparable glycemic control and hypoglycaemia in adults with type 2 diabetes after initiating insulin glargine 300 units/mL or insulin degludec: the DELIVER Naïve D real-world study Sullivan SS 1 , Nicholls CJ 2 , Gupta RA 3 , Menon AA 3 , Wu J 4 , Westerbacka J 5 , Bosnyak Z 5 , Frias JP 6 , Bailey TS 7 1 The CHOICE Institute, School of Pharmacy, University of Washington, Seattle, WA; 2 Sanofi, Guildford, UK; 3 Accenture, Florham Park, New Jersey; 4 Sanofi, Bridgewater, NJ; 5 Sanofi, Paris, France; 6 National Research Institute, Los Angeles, CA; 7 AMCR Institute, Escondido, CA Diabetes Obes Metab 2019; 21: 1-10…”