Head-to-head, second-generation basal insulins barely differ

  • Rosenstock J & al.
  • Diabetes Care
  • 13 Aug 2018

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • For patients with type 2 diabetes (T2D), glargine 300 U/mL (Toujeo/Gla-300) and degludec 100 U/mL (Tresiba/IDeg-100) provide similar glycemic control improvements with relatively low hypoglycemia risk.
  • Choice may be based on access, cost, and clinical considerations.

Why this matters

  • No previous direct clinical comparisons between second-generation longer-acting basal insulin analogs in T2D.

Study design

  • Multicenter, open-label, active-controlled, 2-arm, parallel-group, 24-week, noninferiority study in insulin-naive patients with uncontrolled T2D, randomly assigned to evening comparable titrated doses of Gla-300 or IDeg-100.
  • Intent-to-treat population included 462 participants per arm.
  • Funding: Sanofi.

Key results

  • Mean HbA1c decreased from baseline 8.7% in Gla-300 group and 8.6% in IDeg-100 group to 7.0% in both.
  • Mean difference for Gla-300 vs IDeg-100 was −0.05% (95% CI, −0.15 to 0.05, demonstrating noninferiority). 
  • Incidence of confirmed hypoglycemia (≤70 mg/dL) at any time of day was 66.5% with Gla-300 vs 69.0% with IDeg-100 (OR, 0.88, 95% CI, 0.66-1.17).
  • During the first 12 weeks, rates of hypoglycemia ≤70 and ≤54 mg/dL were lower with Gla-300 vs IDeg-100 (P=.023 and .038, respectively).

Limitations

  • Open-label design.
  • Relatively short duration.

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