Favorable Outcomes With Second-Generation Insulin Analogs in Type 2 Diabetes
Basal insulin is recommended by US guidelines as a treatment option for individuals with type 2 diabetes uncontrolled with metformin.
Patients with type 2 diabetes mellitus who switched from first-generation to second-generation basal insulin analogs, either insulin glargine 300 units/mL or insulin degludec, showed comparable improvement in glycemic control, according to a study recently published in Diabetes, Obesity and Metabolism.
This retrospective study (DELIVER D+) compared the incidence of glycated hemoglobin (HbA1c) reduction, HbA1c goal attainment, and hypoglycemia between adults with type 2 diabetes switching from insulin glargine 100 units/mL to insulin glargine 300 units/mL (n=1592) and from insulin detemir to insulin degludec (n=1592). The study analyzed 5 subpopulations: patients taking basal and prandial insulins, patients with moderate to severe renal impairment, patients with a baseline HbA1c ≥8.0%, patients at high risk for hypoglycemia, and patients >65 years of age.
Both basal insulin analogs had similar HbA1c reductions and goal attainments. Insulin glargine did show a significant reduction in hypoglycemic events from baseline to 6 months. These results were stable among all 5 subpopulations.
The researchers concluded “that switching from a first-generation ([insulin glargine 100 units/mL or insulin detemir]) to a second-generation ([insulin glargine 300 units/mL or insulin degludec]) basal insulin analogue resulted in post-switch improvements in glycaemic control and hypoglycemia incidence.”
This study was supported by Sanofi.
Sullivan SD, Bailey TS, Roussel R, et al. Clinical outcomes in real-world patients with type 2 diabetes switching from first- to second-generation basal insulin analogues: Comparative effectiveness of insulin glargine 300 units/mL and insulin degludec in the DELIVER D+ cohort study [published online June 25, 2018]. Diabetes Obes Metab. doi: 10.1111/dom.13345