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Switch Trials: Degludec versus Glargine

Conference Annotation with Vivian A. Fonseca / ADA 76th Scientific Sessions, New Orleans, June ‘16

Elsevier Digital Insulin Educational Programme: Extra Fonseca nr 1

Professor Fonseca, Tullis–Tulane Alumni Chair in Diabetes, Tulane University of Medicine, New Orleans, discusses different crossover trials in diabetic patients switched from glargine to decludec which were presented at the recent 76th scientific session of the American Diabetes Association 2016 in New Orleans, US, June 10-14.  

Crossover studies with differently dosed insulin analogs

Long-acting insulin analogs have been shown to reduce rates of hypoglycemia. Two trials presented at the ADA have focused on the risks of hypoglycemia after treatment with the insulin analog degludec (IDeg) versus the insulin analog glargine (IGlar) in crossover trials. The crossover design has the advantage, that both insulin analogs are assigned to the same individual, but have limitations such as the carry over effect. Both studies showed less hypoglycemia with IDeg in patients who were switched from IGlar. The HBA1c fell with both insulin analogs. These studies used U100 IDeg and a higher dose of IGlar  – the variances in hypoglycemia might therefore be due to the different concentrations of the insulin analogs.

Comparison of U100 IDeg and IGlar

In the SWITCH trials the same concentrations of IDeg and IGlar were compared (U100). Treatment with IDeg resulted in lower rates of severe hypoglycemia compared with IGlar. Although the reduction was small, it was statistically significant and clinically meaningful. The patients were selected to be at high risk for hypoglycemia. They had prior hypoglycemia or other risk factors such as renal insufficiencies. To what extent different kinetics for the insulin analogs are responsible for the outcome in patients with renal insufficiencies have to be resolved. Overall for patients at high risk for hypoglycemia a switch from IGlar to IDeg might be a progress.

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