Yoshiyuki Hamamoto1,2, Sachiko Honjo3, Kanta Fujimoto3, Shinsuke Tokumoto3, Hiroki Ikeda3,4, Yoshiharu Wada3, Hiroyuki Koshiyama3. 1. Center for Diabetes and Endocrinology, The Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan. hamamoto@kitano-hp.or.jp. 2. Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka, 553-0003, Japan. hamamoto@kitano-hp.or.jp. 3. Center for Diabetes and Endocrinology, The Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan. 4. Ikeda Hospital, Ikeda, Hyogo, Japan.
Abstract
BACKGROUND AND OBJECTIVES: Ultra-long-acting insulin degludec (DEG) has a longer duration of action and less daily variability relative to other basal insulin (BI), and thus may benefit patients with type 1 diabetes mellitus (T1DM). We examined the impact of switching BI to DEG on glycemic control and insulin dose in T1DM. METHODS: T1DM patients (n = 22; six male; mean age: 64.5 ± 12.6 years) receiving basal-bolus insulin therapy were included. Initially, the BI dose was replaced with DEG in a 1:1 ratio; 80-100% of the total dose was replaced with DEG for multiple basal insulin injections. DEG was titrated according to study protocol. Changes in HbA1c, daily insulin dose, glycemic self-monitored blood glucose variations, and hypoglycemia frequency were evaluated for 24 weeks. RESULTS: Once-daily DEG significantly decreased HbA1c levels when switched from once-daily BI (7.9 ± 0.8 vs. 7.5 ± 0.9%, p = 0.020) and maintained HbA1c when switched from twice-daily BI (8.5 ± 1.6 vs. 8.4 ± 1.2%, p = 0.457). The BI dose decreased by -7.8 ± 13.9% (p = 0.017) and -16.6 ± 16.9% (p = 0.050) when switched from once-daily BI and twice-daily BI, respectively. The total bolus insulin dose significantly decreased when switched from once-daily BI (21.7 ± 8.3 to 19.3 ± 8.8 U/day, p = 0.016) especially in the injection before breakfast and evening meal. Body weight and hypoglycemia frequency was not significantly different. CONCLUSION: DEG improved glycemic control when switched from once-daily BI and maintained glycemic control when switched from twice-daily BI without increasing hypoglycemia.
BACKGROUND AND OBJECTIVES: Ultra-long-acting insulin degludec (DEG) has a longer duration of action and less daily variability relative to other basal insulin (BI), and thus may benefit patients with type 1 diabetes mellitus (T1DM). We examined the impact of switching BI to DEG on glycemic control and insulin dose in T1DM. METHODS: T1DM patients (n = 22; six male; mean age: 64.5 ± 12.6 years) receiving basal-bolus insulin therapy were included. Initially, the BI dose was replaced with DEG in a 1:1 ratio; 80-100% of the total dose was replaced with DEG for multiple basal insulin injections. DEG was titrated according to study protocol. Changes in HbA1c, daily insulin dose, glycemic self-monitored blood glucose variations, and hypoglycemia frequency were evaluated for 24 weeks. RESULTS: Once-daily DEG significantly decreased HbA1c levels when switched from once-daily BI (7.9 ± 0.8 vs. 7.5 ± 0.9%, p = 0.020) and maintained HbA1c when switched from twice-daily BI (8.5 ± 1.6 vs. 8.4 ± 1.2%, p = 0.457). The BI dose decreased by -7.8 ± 13.9% (p = 0.017) and -16.6 ± 16.9% (p = 0.050) when switched from once-daily BI and twice-daily BI, respectively. The total bolus insulin dose significantly decreased when switched from once-daily BI (21.7 ± 8.3 to 19.3 ± 8.8 U/day, p = 0.016) especially in the injection before breakfast and evening meal. Body weight and hypoglycemia frequency was not significantly different. CONCLUSION: DEG improved glycemic control when switched from once-daily BI and maintained glycemic control when switched from twice-daily BI without increasing hypoglycemia.
Authors: Simon Heller; John Buse; Miles Fisher; Satish Garg; Michel Marre; Ludwig Merker; Eric Renard; David Russell-Jones; Areti Philotheou; Ann Marie Ocampo Francisco; Huiling Pei; Bruce Bode Journal: Lancet Date: 2012-04-21 Impact factor: 79.321
Authors: Alan J Garber; Allen B King; Stefano Del Prato; Seamus Sreenan; Mustafa K Balci; Manuel Muñoz-Torres; Julio Rosenstock; Lars A Endahl; Ann Marie Ocampo Francisco; Priscilla Hollander Journal: Lancet Date: 2012-04-21 Impact factor: 79.321
Authors: B W Bode; J B Buse; M Fisher; S K Garg; M Marre; L Merker; E Renard; D L Russell-Jones; C T Hansen; A Rana; S R Heller Journal: Diabet Med Date: 2013-06-17 Impact factor: 4.359