Endocrine Abstracts

Introduction: New long-acting insulin analogues (insulin degludec –ID- and insulin glargine 300 U/ml –IG300-) have proved, in clinical trials, that improve metabolic control with lower hypoglycemia rate in T2D.

Objective: To assess characteristics of T2D patients who were given ID and IG300 and to evaluate their effect on metabolic control, weight and insulin dose.

Material and methods: We studied T2D patients whose treatment had been modified. We analyzed weight, HbA1c and insulin dose at baseline and 3-6 months after treatment initiation.

Results: Forty-four patients: 61.4% women, mean age 60.5±10.2 years. T2D evolution time: 15.4±8.6 years. Mean BMI: 31±4.4 kg/m². Mean HbA1c: 9.2±1.7%. At baseline, 16% not insulin-treated (4.6% oral antidiabetic drugs –OADs-, 11.4% OADs + GLP1 agonists); 84% treated with long-acting insulin (34.1% insulin glargine, 31.8% insulin detemir, 6.8% pre-mixed insulin, 11.4% insulin NPH) + other therapies (61.4% OADs, 31.8% GLP1 agonists, 25% short-acting insulin). Reason to change: IG300: 91% poor metabolic control, 4.5% twice-daily basal insulin, 4.5% hypoglycemia; ID: 54.5% poor metabolic control, 27.3% twice-daily basal insulin, 18.2% hypoglycemia (P 0.025). Baseline: no differences in age, T2D evolution time, BMI or HbA1c. ID group had higher dose of basal insulin –BI- (50.7±31.7 vs 29.4±19.8; p 0.033), total daily dose –TDD- (59±30.3 vs 37.7±44.9, P 0.036) and units per kg –U/kg- (0.8±0.4 vs 0.4±0.5; P 0.031) vs IG300 group. 3–6 months after: no differences between groups. ID: significant drop in HbA1c (1±1.3%; P 0.003), BI dose (7.7±14.5 U; P 0.008), TDD (8.9±13.3; P 0.016) and U/kg (0.8±0.4 vs 0.6±0.3; P 0.02), maintaining weight. IG300: significant drop in HbA1c (0.8±1.7%; 0.037), maintaining BI dose, TDD, U/kg and weight. Patients switching from other insulin to ID required a significantly lower dose of IB and U/kg, unlike to those switching to IG300 (−7.7±14.5 vs 5.5±14.2; P 0.003 and 0.13±0.1 vs 1.7±0.2 U/kg; P 0.011 respectively).

Conclusions: ID was chosen in patients with high insulin requirements, not only to improve metabolic control, but also to reduce hypoglycemia and insulin dose, while IG300 was mainly used in not insulin-treated patients and in those with poor metabolic control.

A lower dose of insulin is required with ID vs IG300.