Switching from other basal insulins to insulin degludec (IDeg) or insulin glargine 300 U/mL (Gla300) was found to be associated with reduced glycated hemoglobin in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). These findings were published in the Journal of Diabetes Investigation.

Medical records from patients (n=307) with T1D or T2D (n=294) treated at the Tokyo Women’s Medical University in Japan from 2015 to 2019 were retrospectively reviewed. Patients treated with basal insulin who had glycated hemoglobin greater than 7.0% for at least 6 months were switched from NPH, IDeg, or insulin glargine 100 U/mL to IDeg or Gla300 and assessed for clinical outcomes.

The median age of patients with T1D in both the IDeg and Gla300 cohorts was 47 years, and 30.8% and 32.1% were men, respectively. Participants in the IDeg group were more likely to use twice-daily injections (P =.012) and a lower dose (P =.018). The median ages of patients with T2D in the IDeg and Gla300 cohorts were 65 years and 64 years, respectively, and 58.5% and 56.1% were men, respectively. Participants in the IDeg group received a lower dose (P =.005), and fewer received glucagon-like peptide 1 receptor agonists (P =.017) or sodium-glucose cotransporter-2 inhibitors (P <.001).


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After switching to IDeg or Gla300, glycated hemoglobin (adjusted mean difference [aMD], -0.28%±0.11% vs -0.29%±0.08%), doses of basal insulin (aMD, -0.04±0.01 vs -0.02±0.01 U/kg), and total insulin (aMD, -0.05±0.01 vs -0.02±0.02 U/kg) were decreased, and BMI (aMD, 0.11±0.08 vs 0.11±0.11 kg/m2) was increased among the T1D cohort.

For the T2D cohort, glycated hemoglobin decreased after switching among the IDeg and Gla300 cohorts (aMD, -0.62%±0.17% vs -0.50%±0.17%, respectively). BMI was increased among the IDeg group (aMD, 0.15±0.15 kg/m2) and decreased among the Gla300 cohort (aMD, -0..09±0.15 kg/m2). Little to no change in doses of basal insulin (aMD, -0.01±0.01 vs 0.00±0.01 U/kg) or total insulin (aMD, -0.02±0.02 vs 0.00±0.02 U/kg) was observed for the IDeg and Gla300 recipients, respectively.

IDeg was associated with greater decreases in basal insulin doses for T1D (adjusted odds ratio [aOR], 2.48; 95% CI, 1.30-4.76) and T2D (aOR, 2.43; 95% CI, 1.00-5.88), and total insulin doses for T1D (aOR, 3.34; 95% CI, 1.74-6.43) and T2D (aOR, 2.77; 95% CI, 1.39-5.52).

This study may have been biased by previous insulin type, as patients who were on insulin glargine 100 U/mL were more likely to be switched to Gla300 than IDeg.

These study data indicate that both IDeg and Gla300 successfully reduced glycated hemoglobin in patients with diabetes but that IDeg was more successful at reducing insulin intake and Gla300 was more successful at reducing BMI among patients with T2D.

Reference

Oya J, Nakagami T, Hasegawa Y, Katamine A, Kondo Y, Babazono T. Comparative clinical outcomes of insulin degludec and insulin glargine 300 U/mL after switching from other basal insulins in real-world patients with type 1 and type 2 diabetes. J Diabetes Investig. Published online May 3, 2021. doi:10.1111/jdi.13559