New Long-Acting Basal Insulins: Does Benefit Outweigh Cost?

Standl, Eberhard; Owen, David R.

doi:10.2337/dcs15-3011

Cited by 27 publications

(29 citation statements)

References 51 publications

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“…Nocturnal hypoglycaemia is a widely recognised and feared complication of diabetes mellitus, representing a barrier to treatment intensification for some patients, with a detrimental impact on quality of life and/or serious clinical consequences [10][11][12]. It is therefore of importance that nocturnal hypoglycaemia was significantly reduced with IDe-gAsp, compared with IGlar U100 + IAsp.…”

Section: Discussionmentioning

confidence: 99%

Similar glycaemic control with less nocturnal hypoglycaemia in a 38-week trial comparing the IDegAsp co-formulation with insulin glargine U100 and insulin aspart in basal insulin-treated subjects with type 2 diabetes mellitus

Philis‐Tsimikas

Astamirova²,

Gupta

et al. 2019

Diabetes Research and Clinical Practice

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To confirm non-inferiority of insulin degludec/insulin aspart (IDegAsp) once-daily (OD) versus insulin glargine (IGlar) U100 OD + insulin aspart (IAsp) OD for HbA 1c after 26 weeks, and compare efficacy and safety between groups at W26 + W38. Methods: A 38-week, randomised, open-label, treat-to-target (HbA 1c < 7.0%) trial in adults with type 2 diabetes mellitus (on basal insulin ± oral antidiabetic drugs; HbA 1c 7.0-10.0%). Randomisation (1:1): IDegAsp or IGlar U100 + IAsp. Intensification to IDegAsp twice daily (BID) was permitted at W26 + W32, or with additional IAsp injections at W26 (maximum IAsp BID) or W32 (maximum IAsp three-times daily). Results: For W0-W26, mean percentage-change (standard deviation) HbA 1c was: IDegAsp, À1.1 (0.9); IGlar U100 + IAsp, À1.1 (0.8); estimated treatment difference: 0.07% (95% confidence interval [CI]: À0.06; 0.21) confirmed non-inferiority. At W26 and W38, target HbA 1c achievement, and mean fasting and postprandial glucose were similar across groups. At W38, more subjects achieved target HbA 1c without hypoglycaemia with IDegAsp (22.5%) than with IGlar U100 + IAsp (21.1%), with significantly fewer nocturnal episodes (W0-W38, estimated rate ratio: 0.61 [95% CI: 0.40; 0.93]). Safety profiles were similar across treatment groups throughout. Conclusions: IDegAsp OD/BID are effective treatment intensification options versus multiple injection basal-bolus therapies, achieving similar glycaemic control, with significantly less nocturnal hypoglycaemia.

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Section: Discussionmentioning

confidence: 99%

Similar glycaemic control with less nocturnal hypoglycaemia in a 38-week trial comparing the IDegAsp co-formulation with insulin glargine U100 and insulin aspart in basal insulin-treated subjects with type 2 diabetes mellitus

Philis‐Tsimikas

Astamirova²,

Gupta

et al. 2019

Diabetes Research and Clinical Practice

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“…Differences between Gla300 and Deg have been reported in their mechanism of action 24,25 , half-life 26 , duration of action 16,27 and fluctuations in blood glucose levels due to glucose clamp 28 . However, with respect to safety, Gla300 tended to be associated with a lower incidence of hypoglycemia than Deg, and the incidence of nocturnal hypoglycemia was significantly lower for Gla300.…”

Section: Discussionmentioning

confidence: 99%

“…However, with respect to safety, Gla300 tended to be associated with a lower incidence of hypoglycemia than Deg, and the incidence of nocturnal hypoglycemia was significantly lower for Gla300. It has been reported that Deg has a half-life of 25 h and a duration of action of >42 h 26,27 , whereas Gla300 has a half-life of 18 h and a duration of action of >24 h 16,26 . When we investigated the causes for the higher incidence of Values are expressed as meansstandard deviation.…”

Section: Discussionmentioning

confidence: 99%

“…However, with respect to safety, Gla300 tended to be associated with a lower incidence of hypoglycemia than Deg, and the incidence of nocturnal hypoglycemia was significantly lower for Gla300. Differences between Gla300 and Deg have been reported in their mechanism of action 24,25 , half-life 26 , duration of action 16,27 and fluctuations in blood glucose levels due to glucose clamp 28 . When we investigated the causes for the higher incidence of Values are expressed as meansstandard deviation.…”

Section: Discussionmentioning

confidence: 99%

“…Metformin is known to inhibit hepatic gluconeogenesis 29,30 . It has been reported that Deg has a half-life of 25 h and a duration of action of >42 h 26,27 , whereas Gla300 has a half-life of 18 h and a duration of action of >24 h 16,26 . In the present study, because both formulations were administered in the morning, the difference in duration of action presumably contributed to the difference in the incidence of nocturnal hypoglycemia.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of insulin glargine 300 U/mL and insulin degludec using flash glucose monitoring: A randomized cross‐over study

Yamabe¹,

Kuroda²,

Hirosawa³

et al. 2018

J of Diabetes Invest

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A practical approach to the clinical challenges in initiation of basal insulin therapy in people with type 2 diabetes

Forst

Choudhary

Schneider³

et al. 2020

Diabetes Metabolism Res

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Initiating insulin therapy with a basal insulin analogue has become a standard of care in the treatment of type 2 diabetes mellitus (T2DM). Despite increasing choices in pharmacological approaches, intensified glucose monitoring and improvements in quality of care, many patients do not achieve the desired level of glycaemic control. Although insulin therapy, when optimized, can help patients reach their glycaemic goals, there are barriers to treatment initiation on both the side of the patient and provider. Providers experience barriers based on their perceptions of patients' capabilities and concerns. They may lack the confidence to solve the practical problems of insulin therapy and avoid decisions they perceive as risky for their patients. In this study, we review recommendations for basal insulin initiation, focussing on glycaemic targets, titration, monitoring, and combination therapy with non‐insulin anti‐hyperglycaemic medications. We provide practical advice on how to address some of the key problems encountered in everyday clinical practice and give recommendations where there are gaps in knowledge or guidelines. We also discuss common challenges faced by people with T2DM, such as weight gain and hypoglycaemia, and how providers can address and overcome them.

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New Long-Acting Basal Insulins: Does Benefit Outweigh Cost?

Cited by 27 publications

References 51 publications

Similar glycaemic control with less nocturnal hypoglycaemia in a 38-week trial comparing the IDegAsp co-formulation with insulin glargine U100 and insulin aspart in basal insulin-treated subjects with type 2 diabetes mellitus

Similar glycaemic control with less nocturnal hypoglycaemia in a 38-week trial comparing the IDegAsp co-formulation with insulin glargine U100 and insulin aspart in basal insulin-treated subjects with type 2 diabetes mellitus

Comparison of insulin glargine 300 U/mL and insulin degludec using flash glucose monitoring: A randomized cross‐over study

A practical approach to the clinical challenges in initiation of basal insulin therapy in people with type 2 diabetes

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