Experience after switching from insulin glargine U100 to glargine U300 in patients with type 1 diabetes mellitus. A study after one year of treatment in real life

Insulin Doses Requirements in Patients with Type 1 Diabetes Using Glargine U300 or Degludec in Routine Clinical Practice

“…Therefore, approximately half (40%-60%) of total daily insulin doses in patients with T1D using multiple daily injections is given as basal insulin, dependent on body weight and insulin sensitivity, and the rest is divided into meal-related doses, mainly based on carbohydrate content 38 39. In our population, daily basal insulin doses were 58% of the daily total doses, similarly to other national studies in T1D reporting that daily basal doses ranged 55%-63% of daily total insulin doses and could be explained, in part, for Mediterranean diet and lifestyle followed by the Spanish populations,20 40 in contrast with studies in other countries in patients with T1D where daily basal insulin requirements usually are ≤50% 21 27 31 39…”

“…Thus, some recent RWS reported that patients with T1D using IGla-300, transferred from another basal insulin, have significant reductions in HbA1c levels,17 22 23 with no change in weight17 22 23 or DIDR 17 23 30. However, other studies in routine practice settings have reported higher DIDR ranged from 6.5% to 10.1% after switching to U300 from U100, mainly in the first 6 months 19 20 29. On the other hand, in RCTs comparing IDeg with either glargine or detemir in patients with T1D, IDeg daily doses at end point are usually lower than comparators 13 26 37.…”

“…The second-generation long-acting insulin analogs, glargine U300 UI/mL (IGla-300) and degludec (IDeg), were introduced in 2015 and have shown, in randomized controlled trials (RCTs), an increased stability, which translates to an increased flexibility in timing of administration12 13 and reduced risk of hypoglycemia compared with glargine U100 UI/mL insulin (IGla-100),14 15 results that have been reproduced in several real-world studies (RWS),16–21 although others have reported no differences in hypoglycemia between first-generation and second-generation basal analogs 22–25. Otherwise, a number of RCTs and RWS have reported higher daily insulin doses requirements (DIDR) with IGla-30012 15 20 and lower with IDeg,13 14 18 21 compared with IGla-100, although some studies failed to detect these difference 17 23–31…”

Insulin Glargine in Type 1 Diabetes Mellitus: A Review of Clinical Trials and Real-world Evidence Across Two Decades

“…The commonly cited reasons for the switch from previous BIs were lack of efficacy and hypoglycemia concerns, which would be indicative of these two being the most important guiding factors behind the decision about which insulin to initiate. This study revealed a 94% persistence with Gla-300, suggesting good tolerability [ 31 , 32 ]. The REALITY study, having people with T1DM switched from Gla-100, NPH, and detemir to Gla-300, also mirrored the effectiveness and safety findings from SPARTA study [ 32 , 33 ].…”

“…Gla-300 has been evaluated against Gla-100 in multiple clinical trials in T1DM (Table 2 ) [ 19 - 31 ]. In both EDITION-4 and EDITION-JP1 trials, for a comparable glucose-lowering efficacy between Gla-300 and Gla-100, the pre-dinner self-monitoring of plasma glucose (SMPG) in EDITION-JP1 trial was found to be significantly better with Gla-300 at the 6-month follow-up [ 26 , 29 ].…”