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Díez-Fernández A, Cavero-Redondo I, Moreno-Fernández J, Pozuelo-Carrascosa DP, Garrido-Miguel M, Martínez-Vizcaíno V. Effectiveness of insulin glargine U-300 versus insulin glargine U-100 on nocturnal hypoglycemia and glycemic control in type 1 and type 2 diabetes: a systematic review and meta-analysis. Acta Diabetol 2019; 56:355-364. [PMID: 30506484 DOI: 10.1007/s00592-018-1258-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023]
Abstract
AIMS To assess the effectiveness of insulin glargine 300 ui/ml (Gla-300) compared with insulin glargine 100 ui/ml (Gla-100) on reducing nocturnal hypoglycemia and improving glycemic control in type 1 and type 2 diabetes patients. METHODS We systematically searched in Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials until July 4th, 2018. This study was registered with PROSPERO (CRD42017080134). We included randomized clinical trials comparing Gla-300 versus Gla-100 reporting the rate ratio or number of events of nocturnal hypoglycemia and HbA1c levels percentage or mmol/mol-1. The main outcome was the incidence rate ratio (RR) of nocturnal hypoglycemia events. The heterogeneity of results across studies was assessed using the I2 statistic. Fixed- and random-effect models were used to estimate pooled RRs. RESULTS Nine studies were included in the meta-analysis, including 3977 adult patients. Compared with Gla-100, the use of Gla-300 reduced confirmed nocturnal hypoglycemia [RR = 0.81 (0.69, 0.95)] and clinically significant nocturnal hypoglycemia [RR = 0.75 (0.63, 0.91)]. Reductions in clinically significant nocturnal hypoglycemia events [RR = 0.64 (0.42, 0.97)] in type 1 diabetes patients were found. A small decrease in HbA1c levels in favor of Gla-300 in the pooled sample was identified [ES = - 0.08 (95% CI - 0.14, - 0.01)]. CONCLUSIONS The best current evidence indicates that Gla-300 reduces the incidence of nocturnal hypoglycemia with slight improvements in glycemic control compared with Gla-100 in both type 1 and type 2 diabetes adult patients.
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Affiliation(s)
- Ana Díez-Fernández
- Health and Social Research Centre, Universidad de Castilla-La Mancha, C/ Santa Teresa Jornet, s/n, 16071, Cuenca, Spain
- Faculty of Nursing, Universidad de Castilla-La Mancha, Camino del Pozuelo, s/n, 16071, Cuenca, Spain
| | - Iván Cavero-Redondo
- Health and Social Research Centre, Universidad de Castilla-La Mancha, C/ Santa Teresa Jornet, s/n, 16071, Cuenca, Spain.
| | - Jesús Moreno-Fernández
- Department of Endocrinology and Nutrition, Ciudad Real General University Hospital, C/ Obispo Rafael Torija, s/n, 13005, Ciudad Real, Spain
| | - Diana P Pozuelo-Carrascosa
- Health and Social Research Centre, Universidad de Castilla-La Mancha, C/ Santa Teresa Jornet, s/n, 16071, Cuenca, Spain
| | - Miriam Garrido-Miguel
- Health and Social Research Centre, Universidad de Castilla-La Mancha, C/ Santa Teresa Jornet, s/n, 16071, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Centre, Universidad de Castilla-La Mancha, C/ Santa Teresa Jornet, s/n, 16071, Cuenca, Spain
- Faculty of Health Sciences, Autonomous University of Chile, 5 y Medio Norte, 1670, Talca, Chile
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Miura H, Sakaguchi K, Okada Y, Otowa-Suematsu N, Yamada T, So A, Komada H, Hirota Y, Kishi M, Takeda A, Tominaga Y, Nakamura T, Kuroki Y, Matsuda T, Iida K, Kajikawa M, Ohara T, Yokota K, Hara K, Tateya S, Tamori Y, Ogawa W. Effects of Insulin Degludec and Insulin Glargine U300 on Day-to-Day Fasting Plasma Glucose Variability in Individuals with Type 1 Diabetes: A Multicenter, Randomized, Crossover Study (Kobe Best Basal Insulin Study 2). Diabetes Ther 2018; 9:2399-2406. [PMID: 30341665 PMCID: PMC6250619 DOI: 10.1007/s13300-018-0523-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Administered basal insulin markedly influences the fasting plasma glucose (FPG) level of individuals with type 1 diabetes. Insulin degludec (IDeg) and insulin glargine U300 (IGlar U300) are now available as ultra-long-acting insulin formulations, but whether or how their glucose-stabilizing effects differ remains unclear. We will compare the effects of these basal insulins on parameters related to blood glucose control, with a focus on day-to-day glycemic variability, in individuals with type 1 diabetes treated with multiple daily injections. METHODS A multicenter, randomized, open-label, crossover, comparative study (Kobe Best Basal Insulin Study 2) will be performed at 13 participating institutions in Japan. A total of 46 C-peptide-negative adult outpatients with type 1 diabetes will be randomly assigned 1:1 by a centralized allocation process to IGlar U300 (first period)/IDeg (second period) or IDeg (first period)/IGlar U300 (second period) groups, in which subjects will be treated with the corresponding basal insulin for consecutive 4-week periods. The basal insulin will be titrated to achieve an FPG of less than 130 mg/dL initially and then less than 110 mg/dL if feasible. In the last week of each period, plasma glucose will be determined seven times a day by self-monitoring of blood glucose (SMBG) and intraday and day-to-day glucose excursions will be determined by flash glucose monitoring (FGM). The primary end point is comparison of day-to-day glycemic variability as evaluated by the standard deviation (SD) of FPG during the last week of each treatment period. Secondary end points include the coefficient of variance of FPG, the frequency of severe hypoglycemia as evaluated by SMBG, the duration of hypoglycemia as evaluated by FGM, intraday glycemic variability calculated from both SMBG and FGM data, and the administered insulin dose. PLANNED OUTCOMES The results of the study will be submitted for publication in a peer-reviewed journal to report differences in the effects of two ultra-long-acting basal insulins, IDeg and IGlar U300. CONCLUSION This head-to-head comparison will be the first study to compare the effects of IDeg and IGlar U300 on day-to-day FPG variability in C-peptide-negative individuals with type 1 diabetes. TRIAL REGISTRATION Registered in University Hospital Medical Information Network (UMIN) Clinical Trials Registry as 000029630 on 20 June 2017. FUNDING Novo Nordisk Pharma Ltd.
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Affiliation(s)
- Hiroshi Miura
- Division of Diabetes and Endocrinology Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuhiko Sakaguchi
- Division of Diabetes and Endocrinology Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
- Division of General Internal Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Yuko Okada
- Division of Diabetes and Endocrinology Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Natsu Otowa-Suematsu
- Division of Diabetes and Endocrinology Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoko Yamada
- Division of Diabetes and Endocrinology Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Anna So
- Division of Diabetes and Endocrinology Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hisako Komada
- Division of Diabetes and Endocrinology Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Minoru Kishi
- Department of Internal Medicine, Nishiwaki Municipal Hospital, Nishiwaki, Japan
| | - Akihiko Takeda
- Department of Diabetic and Metabolic Medicine, Shinko Hospital, Kobe, Japan
| | - Yoichi Tominaga
- Department of Diabetology and Endocrinology, Takatsuki General Hospital, Takatsuki, Japan
| | - Tomoaki Nakamura
- Department of Diabetes and Endocrinology, Kobe Rosai Hospital, Kobe, Japan
| | - Yasuo Kuroki
- Department of Internal Medicine, Kobe Century Memorial Hospital, Kobe, Japan
| | - Tomokazu Matsuda
- Department of Internal Medicine, Kaisei Diabetes Clinic, Kobe, Japan
| | - Keiji Iida
- Division of Diabetes and Endocrinology, Hyogo Prefectural Kakogawa Medical Center, Kakogawa, Japan
| | - Michiko Kajikawa
- Department of Internal Medicine, Yodogawa Christian Hospital, Osaka, Japan
| | - Takeshi Ohara
- Department of Diabetes and Endocrinology, Hyogo Brain and Heart Center, Himeji, Japan
| | - Kazuki Yokota
- Department of Internal Medicine, Yokota Medical Clinic, Akashi, Japan
| | - Kenta Hara
- Department of Diabetes and Endocrine disease, Kita-harima Medical Center, Ono, Japan
| | - Sanshiro Tateya
- Department of Internal Medicine, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Yoshikazu Tamori
- Division of Diabetes and Endocrinology Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
- Division of Creative Health Promotion, Department of Social/Community Medicine and Health Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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George CM, Byun A, Howard-Thompson A. New Injectable Agents for the Treatment of Type 2 Diabetes Part 1 - Injectable Insulins. Am J Med 2018; 131:752-754. [PMID: 29496503 DOI: 10.1016/j.amjmed.2018.01.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/22/2018] [Accepted: 01/22/2018] [Indexed: 10/17/2022]
Abstract
The United States Food and Drug Administration has recently approved several new insulin products and new formulations of existing insulin products. These new products may provide advantages over older products, such as a lower risk of nocturnal hypoglycemia and ease of dosing; however, they are costly. The first of 2 articles in a series, this review will describe the potential advantages and disadvantages of these new insulin products.
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Affiliation(s)
- Christa M George
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis; Department of Family Medicine, University of Tennessee Health Science Center, Memphis.
| | - AhYoung Byun
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis
| | - Amanda Howard-Thompson
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis; Department of Family Medicine, University of Tennessee Health Science Center, Memphis
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Bohn B, Bramlage P, Wagner C, Kaltheuner M, Welp R, Sziegoleit S, Zimmermann A, Reuter HM, Hummel M, Gloyer J, Holl RW, Danne T. Welche Patienten aus der Routinebetreuung verwenden das neue Insulin-Analogon Glargin U300 im Vergleich zu Patienten mit Glargin U100? Wien Med Wochenschr 2017; 168:415-422. [DOI: 10.1007/s10354-017-0589-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/17/2017] [Indexed: 11/30/2022]
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Owens DR. Pharmacokinetics and pharmacodynamics of insulin glargine 300 U/mL in the treatment of diabetes and their clinical relevance. Expert Opin Drug Metab Toxicol 2017; 12:977-87. [PMID: 27453980 DOI: 10.1080/17425255.2016.1202916] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION A more concentrated insulin glargine formulation, containing 300 U/mL (Gla-300) was approved in 2015 in the US and Europe for the treatment of diabetes mellitus in adults. AREAS COVERED This drug evaluation focuses on the pharmacokinetics (PK) and pharmacodynamics (PD) of Gla-300 from studies published up to May 2016. The clinical relevance of this new formulation will be addressed. EXPERT OPINION Gla-300 was developed to produce a flatter and more prolonged PK/PD profile compared with insulin glargine 100 U/mL (Gla-100) in order to maintain effective glycemic control and reduce the risk of hypoglycemia. Compared to Gla-100, Gla-300 achieves lower and delayed peak concentrations with a PK exposure that is more stable and evenly distributed across a 24-h dosing interval. As a consequence, Gla-300 results in a consistent glucose-lowering effect with less variability over a 24-h dosing interval, which translates to a reduction in the rate of hypoglycemia (particularly nocturnal events).
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Affiliation(s)
- David R Owens
- a Diabetes Research Group , Swansea University , Swansea , UK
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Abstract
Newer insulin products have advanced the evolution of insulin replacement options to more accurately mimic natural insulin action. There are new, modified, and concentrated insulins; administration devices calibrated for both increased concentrations and administration accuracy to improve adherence and safety; and inhaled insulin. There are new combinations of longer-acting basal insulin and rapid-acting insulin or glucagon like protein-1 receptor agonists. Existing insulin replacement designs and methods can be updated using these tools to improve efficacy and safety. Individualized decisions to use them should be based on patient physiologic needs, self-care ability, comorbidities, and cost considerations.
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Affiliation(s)
- Alissa R Segal
- Department of Pharmacy Practice, MCPHS University, 179 Longwood Avenue, Boston, MA 02115, USA; Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215, USA.
| | - Tejaswi Vootla
- Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215, USA
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