Comparative Benefits and Harms of Basal Insulin Analogues for Type 2 Diabetes

Madenidou, Anastasia-Vasiliki; Paschos, Paschalis; Karagiannis, Thomas; Katsoula, Anastasia; Athanasiadou, Eleni; Kitsios, Konstantinos; Bekiari, Eleni

doi:10.7326/m18-0443

Cited by 44 publications

(38 citation statements)

References 50 publications

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“…This finding is consistent with emerging data on the comparative effectiveness and safety of different basal insulins for type 2 diabetes. 34,35 Two studies published in 2018 reported similar associations of different basal formulations with glucoselowering ability in real-world practice. 34,35 The existing literature has mainly concentrated on patients with type 2 diabetes who do not use insulin and the extent to which nonmodifiable factors are associated with diabetes control.…”

Section: Discussionmentioning

confidence: 98%

“…34,35 Two studies published in 2018 reported similar associations of different basal formulations with glucoselowering ability in real-world practice. 34,35 The existing literature has mainly concentrated on patients with type 2 diabetes who do not use insulin and the extent to which nonmodifiable factors are associated with diabetes control. 7,8,10,36 For example, age and duration of diabetes have been elucidated as factors associated with a patient's glycemic control.…”

Section: Discussionmentioning

confidence: 98%

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Association of Potentially Modifiable Diabetes Care Factors With Glycemic Control in Patients With Insulin-Treated Type 2 Diabetes

et al. 2020

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IMPORTANCE Numerous factors are associated with the ability of patients with type 2 diabetes to achieve optimal glycemic control. However, many of these factors are not modifiable by quality improvement interventions. In contrast, the structure of how diabetes care is delivered, such as whether patients visit an endocrinologist or how prescriptions are filled, is potentially modifiable, yet its associations with glycemic control have not been rigorously evaluated. OBJECTIVE To investigate the association of diabetes care delivery with glycemic control in patients with type 2 diabetes using insulin. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used baseline claims and laboratory insurer data within a large pragmatic trial to identify individuals with type 2 diabetes using insulin with data for at least 1 hemoglobin A 1c (HbA 1c) test result from before trial randomization (July 1, 2014, to October 5, 2016) and for key nonmodifiable patient factors as well as diabetes care delivery and behavioral factors measured before the HbA 1c test. Analyses were conducted from February 4, 2017, to November 13, 2018. MAIN OUTCOMES AND MEASURES Multivariable modified Poisson regression was used to evaluate the independent associations of nonmodifiable patient factors and potentially modifiable diabetes care delivery and patient behavioral factors with achieving adequate diabetes control (ie, HbA 1c level <8%). The extent of measured variation explained in glycemic control by these factors was also explored using pseudo R 2 and C statistics. RESULTS Of 1423 patients included, 565 (39.7%) were women, and the mean (SD) age was 56.4 (9.0) years. In total, 690 (48.5%) had HbA 1c levels less than 8%. Age (relative risk [RR] per 1-unit

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Association of Potentially Modifiable Diabetes Care Factors With Glycemic Control in Patients With Insulin-Treated Type 2 Diabetes

et al. 2020

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“…A recent systematic review and network meta-analysis found high-to-moderate evidence that detemir leads to less weight gain compared with all other basal insulins including degludec and glargine U300 and low and very low quality evidence that degludec and glargine U300 were associated with lower incidence of nocturnal hypoglycaemia than detemir and glargine U100. 25 Significantly this comprehensive meta-analysis of 39 trials including 26,195 participants with T2DM did not find significant evidence that any basal insulins were superior in terms of glycaemic effects or severe hypoglycaemic episodes. It must be noted that insulin degludec had higher rates of severe hypoglycaemia in the SWITCH 2 cross-over randomised controlled cross-over trial than insulin glargine U300 in the EDITION 2 randomised controlled trial.…”

Section: Patient Groups Most Likely To Benefitmentioning

confidence: 77%

“…10 A systematic review and network meta-analysis of thirty-nine trials comprising 26,195 patients with T2DM found low and very low quality evidence that reduced risk of nocturnal hypoglycaemia was associated with Degludec U100 and U200 and glargine 300. 25…”

Section: Hypoglycaemiamentioning

confidence: 99%

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

Chatterjee

Khunti

Davies

2019

Drugs

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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.

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“…Four basal insulin analogues (insulin glargine 100 U/mL, insulin detemir, insulin degludec and insulin glargine 300 U/mL) have been introduced since the turn of the last century, challenging neutral protamine Hagedorn (NPH) insulin as the most widely used basal insulin, particularly in people with type 1 diabetes. Randomized trials have shown that the positive effects of these new treatment options are principally lower frequencies of hypoglycaemia and less weight gain, but the debate on the roles of these basal insulin analogues in clinical treatment guidelines remains ongoing [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Treatment with New Basal Insulin Analogues in Type 1 Diabetes: Nation-Wide Survey

et al. 2020

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Introduction:To date, only a few studies have addressed the long-term safety of basal insulins. We have therefore investigated the efficacy and safety of all available basal insulins used in the treatment of type 1 diabetes, using data from national databases in Sweden. Methods: We assessed patients with type 1 diabetes who were using insulin glargine 100 U/mL (IG100) and who either continued using IG100 or switched to insulin glargine 300 U/mL (IG300) or insulin degludec (ID) for differences in clinical characteristics at baseline (index date) and subsequent changes in glycated haemoglobin (HbA1c), weight and hospitalizations caused by hypoglycaemia, cardiovascular disease or death.

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Comparative Benefits and Harms of Basal Insulin Analogues for Type 2 Diabetes

Abstract: None. (PROSPERO: CRD42016037055).

Cited by 44 publications

References 50 publications

Association of Potentially Modifiable Diabetes Care Factors With Glycemic Control in Patients With Insulin-Treated Type 2 Diabetes

Association of Potentially Modifiable Diabetes Care Factors With Glycemic Control in Patients With Insulin-Treated Type 2 Diabetes

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

Efficacy and Safety of Treatment with New Basal Insulin Analogues in Type 1 Diabetes: Nation-Wide Survey

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