medwireNews: Insulin-naive adults with type 2 diabetes derive greater benefit from treatment with insulin degludec than from insulin glargine 300 units/mL (glargine U300), results from the US clinical practice-based CONFIRM study show.
“In the present real-world study, degludec resulted in greater reductions in the rates and likelihood of hypoglycaemia compared with glargine U300; findings that likely contributed to the ability of patients to reach lower HbA1c [glycated hemoglobin] and persist with original insulin therapy with degludec versus glargine U300,” Joseph Tibaldi (Fresh Meadows Diabetes and Endocrinology, New York, USA) and co-authors remark.
The researchers report in Diabetes, Obesity and Metabolism that HbA1c fell by 1.48% from a baseline of 9.60% during the first 180 days of treatment with insulin degludec, compared with a fall of 1.22%, from 9.50%, during initial treatment with glargine U300.
And they note that the estimated treatment difference of 0.27% was “close to the clinically significant reduction of 0.3%.”
The study, which included 2028 propensity-matched insulin-naive patients with type 2 diabetes (mean age 58 years) in each treatment group, also assessed the impact of each insulin on hypoglycemia.
Both groups saw significant rises in the rates of hypoglycemia and the proportion of patients experiencing at least one episode of hypoglycemia during the first 180 days of treatment, but the rate increases were significantly smaller with degludec than with glargine U300.
Specifically, the rate of hypoglycemia increased by a factor of 1.30 with degludec versus 1.85 with glargine U300, which was equivalent to a rate ratio of 0.70 in favor of degludec.
Similarly, the proportion of patients experiencing at least one episode of hypoglycemia increased by a factor of 1.32 with degludec and 2.06 with glargine U300, resulting in a significant 36% lower likelihood for hypoglycemia with degludec.
Furthermore, patients in the degludec group were a significant 27% less likely to have discontinued treatment at 180 days than those in the glargine U300 group, with discontinuation rates of 13.0% and 21.0%, respectively.
Tibaldi and colleagues say their findings “are consistent with previous observations from a pharmacokinetic/pharmacodynamic study of degludec and glargine U300 that identified the potential of degludec to result in a lower risk of hypoglycaemia and a relatively higher dose potency compared with glargine U300.”
They conclude: “[T]his comparative effectiveness study of insulin-naive patients with [type 2 diabetes] has demonstrated that degludec results in significantly larger reductions in HbA1c with a 30% lower risk of hypoglycaemia and reduced likelihood of treatment discontinuation compared with glargine U300.”
By Laura Cowen
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