Insulin degludec vs insulin glargine

  • Zhou W & al.
  • Diabetes Ther
  • 24 Apr 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Insulin degludec and insulin glargine provide similar glycaemic control, but insulin degludec has an overall beneficial effect on type 2 diabetes mellitus (T2DM) management, mainly manifesting in the lower risks for severe and nocturnal hypoglycaemia.

Why this matters

  • Findings suggest that insulin degludec may be an alternative treatment for patients with T2DM who are prone to hypoglycaemia with insulin glargine.

Study design

  • Meta-analysis of 15 studies included 9619 patients in the insulin degludec group and 7075 patients in the insulin glargine group.
  • Main outcomes: glycaemic control, hypoglycaemic event, weight gain and serious adverse events (SAEs).
  • Funding: Natural Science Foundation of China and others.

Key results

  • Mean overall reduction in fasting plasma glucose was in favour of insulin degludec (weighted mean difference [WMD], −5.20 mg/dL; 95% CI, −7.34 to −3.07; P<.00001>
  • Compared with insulin glargine, insulin degludec was associated with a lower ratio of patients experiencing:
    • ≥1 severe hypoglycaemic event (relative risk [RR], 0.68; 95% CI, 0.50-0.93; P=.01) and
    • nocturnal hypoglycaemia (RR, 0.81; 95% CI, 0.75-0.88; P<.0001>
  • Insulin glargine was associated with a higher ratio of patients with HbA1c ≤7.0% vs insulin degludec (RR, 0.92; 95% CI, 0.86-0.98; P=.01).
  • No significant difference observed between the two groups for:
    • HbA1c reduction (WMD, 0.03; 95% CI, −0.00 to 0.07; P=.08),
    • body weight gain (WMD, 0.12; 95% CI, −0.19 to 0.43; P=.46) and
    • proportion of participants with SAEs (RR, 0.97; 95% CI, 0.92-1.02; P=.20).

Limitations

  • Potential risks of bias.
  • Heterogeneity among included studies.

 

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