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Saboo B, Chandalia H, Ghosh S, Kesavadev J, Kochar IPS, Prasannakumar KM, Sarda A, Bantwal G, Mehrotra RN, Rai M. Insulin Glargine in Type 1 Diabetes Mellitus: A Review of Clinical Trials and Real-world Evidence Across Two Decades. Curr Diabetes Rev 2024; 20:e100323214554. [PMID: 36896906 PMCID: PMC10909813 DOI: 10.2174/1573399819666230310150905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/31/2022] [Accepted: 01/17/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Over the past two decades, insulin glargine 100 U/mL (Gla-100) has emerged as the "standard of care" basal insulin for the management of type 1 diabetes mellitus (T1DM). Both formulations, insulin glargine 100 U/mL (Gla-100) and glargine 300 U/mL (Gla- 300) have been extensively studied against various comparator basal insulins across various clinical and real-world studies. In this comprehensive article, we reviewed the evidence on both insulin glargine formulations in T1DM across clinical trials and real-world studies. METHODS Evidence in T1DM for Gla-100 and Gla-300 since their approvals in 2000 and 2015, respectively, were reviewed. RESULTS Gla-100 when compared to the second-generation basal insulins, Gla-300 and IDeg-100, demonstrated a comparable risk of overall hypoglycemia, but the risk of nocturnal hypoglycemia was higher with Gla-100. Additional benefits of Gla-300 over Gla-100 include a prolonged (>24- hours) duration of action, a more stable glucose-lowering profile, improved treatment satisfaction, and greater flexibility in the dose administration timing. CONCLUSION Both glargine formulations are largely comparable to other basal insulins in terms of glucose-lowering properties in T1DM. Further, risk of hypoglycemia is lower with Gla-100 than Neutral Protamine Hagedorn but comparable to insulin detemir.
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Affiliation(s)
- Banshi Saboo
- Department of Endocrinology, Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat, India
| | - Hemraj Chandalia
- Diabetes Endocrine Nutrition Management and Research Centre (DENMARC), Mumbai, Maharashtra, India
| | - Sujoy Ghosh
- Department of Endocrinology, IPGME&R, Kolkata, West Bengal, India
| | - Jothydev Kesavadev
- Department of Endocrinology, Jothydev's Diabetes and Research Centre, Trivandrum, Kerala, India
| | - IPS Kochar
- Department of Endocrinology, Indraprastha Apollo Hospital, New Delhi, India
| | - KM Prasannakumar
- Centre for Diabetes and Endocrine Care, Bangalore Diabetes Hospital, Bengaluru, Karnataka, India
| | - Archana Sarda
- Sarda Centre for Diabetes and Self-care, Aurangabad, Maharashtra, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St. John’s Medical College & Hospital, Bangalore, Karnataka, India
| | - RN Mehrotra
- Department of Endocrinology, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India
| | - Madhukar Rai
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, Uttar Pradesh, India
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Cengiz E, Danne T, Ahmad T, Ayyavoo A, Beran D, Ehtisham S, Fairchild J, Jarosz-Chobot P, Ng SM, Paterson M, Codner E. ISPAD Clinical Practice Consensus Guidelines 2022: Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1277-1296. [PMID: 36537533 DOI: 10.1111/pedi.13442] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Eda Cengiz
- University of California San Francisco (UCSF) Pediatric Diabetes Program, UCSF School of Medicine, San Francisco, California, USA
| | - Thomas Danne
- Auf Der Bult, Diabetes Center for Children and Adolescents, Hannover, Germany
| | - Tariq Ahmad
- Pediatric Endocrinology, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Ahila Ayyavoo
- Department of Pediatrics, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine University of Geneva and Geneva University Hospitals, Faculty of Medicine Diabetes Centre, Geneva, Switzerland
| | - Sarah Ehtisham
- Division of Pediatric Endocrinology, Mediclinic City Hospital, Dubai, UAE
| | - Jan Fairchild
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, North Adelaide, Australia
| | | | - Sze May Ng
- Paediatric Department, Southport and Ormskirk NHS Trust, Southport, UK.,Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Megan Paterson
- John Hunter Children's Hospital, HRMC, New South Wales, Australia
| | - Ethel Codner
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile
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McGill JB, Weiss D, Grant M, Jones MC, Kendall DM, Hoogwerf BJ. Understanding inhaled Technosphere Insulin: Results of an early randomized trial in type 1 diabetes mellitus. J Diabetes 2021; 13:164-172. [PMID: 32737923 DOI: 10.1111/1753-0407.13099] [Citation(s) in RCA: 9] [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: 05/12/2020] [Revised: 07/15/2020] [Accepted: 07/24/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Technosphere Insulin (TI) is an inhaled insulin. Studies comparing TI with short-acting insulin analogues provide important insights on efficacy, dosing, and time course of action. METHODS Planned enrollment of 230 subjects was limited to 138 due to premature study discontinuation. The primary efficacy endpoint was a noninferiority of glycosylated hemoglobin (HbA1c) of 0.4% for TI compared with insulin lispro (LIS) in a 16-week phase 3 randomized clinical trial in type 1 diabetes mellitus. RESULTS HbA1c values were similar in the TI and LIS groups at the beginning of the trial (7.8% and 7.6%, respectively) and at trial endpoint (7.7% and 7.6%, respectively). Least squares mean changes from baseline were similar between study groups. Glucose values after a standard meal were significantly lower with TI in the first 90 minutes post meal compared with LIS. Mild or moderate hypoglycemia event rates were also significantly lower with TI compared with LIS (5.97 vs 8.01, respectively; P = .0269). Cough was the most commonly reported adverse event with TI. Pulmonary function as measured by forced expiratory volume in 1 second was not different between groups at baseline, 16 weeks, or 4 weeks off study drug. CONCLUSIONS HbA1c was unchanged and overall glucose control was comparable between groups. Treatment with TI resulted in improved post-meal glucose and a lower risk of hypoglycemia compared with LIS.
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Affiliation(s)
- Janet B McGill
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St Louis, Missouri, USA
| | - Daniel Weiss
- Your Diabetes Endocrine Nutrition Group, Inc, Mentor, Ohio, USA
| | | | | | | | - Byron J Hoogwerf
- Endocrinology, Diabetes and Metabolism (Emeritus), Cleveland Clinic, Cleveland, Ohio, USA
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Kapellen TM. Pharmacotherapy of Children and Adolescents with Type 1 Diabetes Mellitus. Handb Exp Pharmacol 2020; 261:105-118. [PMID: 31342276 DOI: 10.1007/164_2019_245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Insulin treatment in children and adolescents with autoimmune type 1 diabetes has changed tremendously in the last 20 years with the knowledge of DCCT trial regarding near-normal glucose levels on the micro- and macrovascular outcome. Intensified insulin therapy is now standard of care. Carb counting however was introduced systematically only recently in several countries. In industrialized countries most patients in this age group are treated with continuous subcutaneous insulin injections. Nowadays this is combined with continuous subcutaneous glucose measurement commencing sensor-augmented pump therapy. Predictive low glucose suspend reduces the frequency of hypoglycemic events. Still not available for children is a commercially available closed loop system. However, treatment goals are still frequently not reached especially in the group of adolescents. Therefore several additive drugs are tested to improve treatment results. There are new insulins with faster and longer action profile in the pipeline to better mimic physiologic insulin profiles. Smart insulins may be able to mimic reaction on blood sugar levels. The broad facet of treatment modalities helps pediatric diabetes teams to individualize therapy and so improve patients' health-related quality of life.
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Affiliation(s)
- Thomas M Kapellen
- Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.
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Hegab AM. Prospective evaluation of insulin-to-carbohydrate ratio in children and adolescents with type 1 diabetes using multiple daily injection therapy. Pediatr Diabetes 2019; 20:1087-1093. [PMID: 31433557 DOI: 10.1111/pedi.12911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/28/2019] [Accepted: 08/17/2019] [Indexed: 12/01/2022] Open
Abstract
AIM Assessment of insulin-to-carbohydrate ratio (ICR) in children and adolescents with type 1 diabetes mellitus (T1DM) using multiple daily injection (MDI) therapy. METHODS This prospective observational study was conducted over a 2-year period at Sohag University Hospital, Egypt. Children and adolescents aged 4 to 17 years, diagnosed with T1DM for at least 1 year, with fasting serum C-peptide levels <0.24 ng/dL and whose parents accepted to shift their management to flexible MDI using carbohydrate counting, were included. Participants were initially hospitalized for estimation of ICR and insulin doses, then followed-up monthly for further adjustments. Insulin doses, ICR, and glycemic control parameters were assessed after 3 months. RESULTS The study included 201 participants, 110 (54.7%) of them were males. The median age was 9.5 years (interquartile range: 7-12.5 years). Bolus insulin requirements estimated by the 500 rule were significantly lower than the actual doses used by the study participants for all meals (P < .001). Bolus insulin requirement for morning meal was significantly higher compared to other meals (P < .001). Linear regression analyses between ICR for different meals and the reciprocal of total daily dose (TDD) in 96 participants with optimum glycemic control revealed that ICR could be calculated as 301 to 309/TDD for morning meal (R2 = 0.97, P < .001), 317 to 331/TDD for afternoon meal (R2 = 0.96, P < .001), and 362 to 376/TDD for evening meal (R2 = 0.98, P < .001). CONCLUSIONS Bolus insulin requirements showed diurnal variation. Using 301 to 309/TDD, 317 to 331/TDD, and 362 to 376/TDD formulas would be more appropriate than the 500 rule for initial estimation of ICR for morning, afternoon, and evening meals, respectively.
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Affiliation(s)
- Ahmed M Hegab
- Pediatrics Department, Faculty of Medicine, Sohag University, Egypt
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Al Hayek AA, Robert AA, Al Dawish MA. Differences of FreeStyle Libre Flash Glucose Monitoring System and Finger Pricks on Clinical Characteristics and Glucose Monitoring Satisfactions in Type 1 Diabetes Using Insulin Pump. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2019; 12:1179551419861102. [PMID: 31308786 PMCID: PMC6604122 DOI: 10.1177/1179551419861102] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 06/07/2019] [Indexed: 12/15/2022]
Abstract
Background: To evaluate the different experience of freestyle libre and finger pricks on
clinical characteristics and glucose monitoring satisfaction (GMS) in
patients with type 1 diabetes (T1D) using insulin pump (IP). Methods: A prospective study was carried out on 47 (aged 17-21 years) T1D, who used
conventional finger-pricking method for self-testing the glucose. The
experiments were conducted between March 2018 and September 2018. For
carrying out the study, the flash glucose monitoring (FGM) sensors were
placed on each participant, at the baseline visit, by a trained diabetes
educator. Furthermore, to determine the total number of scans conducted
during the study period, the respective ambulatory glucose profiles were
generated by computing the data collected from the sensors. In addition, a
trained interviewer handed over the GMS questionnaire to each patient, at
the baseline and at 12 weeks of the study. Results: In comparison to the baseline (finger pricks), various parameters such as:
HbA1c (P = .042), hypoglycemia (P = .001),
mean capillary glucose (P = .004), total daily insulin dose
(P = .0001), percentage of bolus insulin
(P = .0001), daily bolus frequency
(P = .0001), and daily carbohydrates intake
(P = .0001) showed a significant improvement at
12 weeks. Similarly, substantial augmentation was noticed, in the sub
domains of GMS, that is, openness (P = .0001), emotional
burden (P = .0001), behavioral burden
(P = .0001), and trust (P = .0001) at
12 weeks as compared to baseline. Overall, total GMS score at baseline was
1.72 ± 0.37, which increased up to 3.41 ± 0.49 (P = .0001)
in the time period of 12 weeks. The HbA1c (r2 = 0.45),
hypoglycemia (r2 = 0.58), and the mean number of FGM scans,
exhibited a negative correlation, while GMS (r2 = 0.52) and the
mean number of FGM scans, exhibited a positive correlation. Conclusion: The frequency of hypoglycemia, HbA1c level, capillary glucose, daily
carbohydrates intake decreased, while the total daily insulin dose, daily
bolus insulin and total GMS score increased with the use of FGM scanning for
12 weeks.
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Affiliation(s)
- Ayman A Al Hayek
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Asirvatham A Robert
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohamed A Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Gloaguen E, Bendelac N, Nicolino M, Julier C, Mathieu F. A systematic review of non-genetic predictors and genetic factors of glycated haemoglobin in type 1 diabetes one year after diagnosis. Diabetes Metab Res Rev 2018; 34:e3051. [PMID: 30063815 DOI: 10.1002/dmrr.3051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 12/13/2022]
Abstract
Type 1 diabetes (T1D) results from autoimmune destruction of the pancreatic βcells. Although all T1D patients require daily administration of exogenous insulin, their insulin requirement to achieve good glycaemic control may vary significantly. Glycated haemoglobin (HbA1c) level represents a stable indicator of glycaemic control and is a reliable predictor of long-term complications of T1D. The purpose of this article is to systematically review the role of non-genetic predictors and genetic factors of HbA1c level in T1D patients after the first year of T1D, to exclude the honeymoon period. A total of 1974 articles published since January 2011 were identified and 78 were finally included in the analysis of non-genetic predictors. For genetic factors, a total of 277 articles were identified and 14 were included. The most significantly associated factors with HbA1c level are demographic (age, ethnicity, and socioeconomic status), personal (family characteristics, parental care, psychological traits...) and features related to T1D (duration of T1D, adherence to treatment …). Only a few studies have searched for genetic factors influencing HbA1c level, most of which focused on candidate genes using classical genetic statistical methods, with generally limited power and incomplete adjustment for confounding factors and multiple testing. Our review shows the complexity of explaining HbA1c level variations, which involves numerous correlated predictors. Overall, our review underlines the lack of studies investigating jointly genetic and non-genetic factors and their interactions to better understand factors influencing glycaemic control for T1D patients.
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Affiliation(s)
- Emilie Gloaguen
- Inserm UMRS-958, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | | | - Marc Nicolino
- Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France
| | - Cécile Julier
- Inserm UMRS-958, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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Danne T, Phillip M, Buckingham BA, Jarosz-Chobot P, Saboo B, Urakami T, Battelino T, Hanas R, Codner E. ISPAD Clinical Practice Consensus Guidelines 2018: Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes 2018; 19 Suppl 27:115-135. [PMID: 29999222 DOI: 10.1111/pedi.12718] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/01/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
- Thomas Danne
- Kinder- und Jugendkrankenhaus AUF DER BULT, Diabetes-Zentrum für Kinder und Judendliche, Hannover, Germany
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Bruce A Buckingham
- Department of Pediatric Endocrinology, Stanford University, Stanford, California
| | | | - Banshi Saboo
- Department of Endocrinology, DiaCare - Advance Diabetes Care Center, Ahmedabad, India
| | - Tatsuhiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Tadej Battelino
- Department Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ragnar Hanas
- Department of Pediatrics, NU Hospital Group, Uddevalla, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ethel Codner
- Institute of Maternal and Child Research (IDMI), School of Medicine, University de Chile, Santiago, Chile
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Silva TBC, Almeida PHRF, Araújo VE, Acurcio FDA, Guerra Júnior AA, Godman B, Alvares J. Effectiveness and safety of insulin glargine versus detemir analysis in patients with type 1 diabetes: systematic review and meta-analysis. Ther Adv Endocrinol Metab 2018; 9:241-254. [PMID: 30181850 PMCID: PMC6116758 DOI: 10.1177/2042018818781414] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 05/16/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Diabetes mellitus type 1 (DM1) is an autoimmune disease characterized by metabolic destruction of pancreatic cells responsible for insulin production, with treatment based on replacing insulin. Long-acting insulin analogs are indicated for patients with DM1 who exhibit important oscillations of their daily glycemia, despite its higher cost. Our study objective was to evaluate the effectiveness and safety of two long-acting insulins, insulin glargine and detemir, in treating patients with DM1. METHODS We undertook a systematic review with meta-analysis of observational studies (cohort and registry) available in the databases and the gray literature, and a complementary search in the Diabetes Care journal. Outcomes assessed were: glycated hemoglobin concentration; fasting plasma or capillary glucose; occurrence of episodes of severe hypoglycemia and occurrence of nocturnal hypoglycemia. The assessment of methodological quality was performed using the Newcastle score. The meta-analyses were performed on software Review Manager® 5.2. RESULTS Out of 705 publications, 8 cohort studies were included. The quality of these studies was classified as high. In the meta-analysis, results regarding episodes of severe hypoglycemia (p = 0.02) and fasting glucose (p = 0.01) were in favor of detemir. The glycated hemoglobin (p = 0.49; I2 = 89) showed high heterogeneity and no statistically significant difference between the two. The meta-analysis of total insulin dose favored glargine (p = 0.006; I2 = 75). The rates of nocturnal hypoglycemia (NH) were evaluated only for one study and showed a significant reduction of NH after therapy with detemir, (p < 0.0001). CONCLUSION Although some outcomes were favorable to detemir insulin analog, it has not been possible to identify important differences of effectiveness and safety between the two analogs. These results can help in the current debate on the inclusion of long-acting analogs on the list of reimbursed medicines in Brazil, especially with the recent introduction of an insulin glargine biosimilar at a considerably lower price.
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Affiliation(s)
- Thales B. C. Silva
- School of Pharmacy, Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil
- SUS Collaborating Center for Technology Assessment and Excellence in Health (CCATES), Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil
| | - Paulo H. R. F. Almeida
- School of Pharmacy, Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil
- SUS Collaborating Center for Technology Assessment and Excellence in Health (CCATES), Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil
| | - Vania E. Araújo
- School of Pharmacy, Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil
- SUS Collaborating Center for Technology Assessment and Excellence in Health (CCATES), Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais Brazil
- School of Dentistry, Pontifícia Universidade Católica de Minas Gerais (PUCMG), Minas Gerais, Brazil
| | - Francisco de Assis Acurcio
- School of Pharmacy, Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil
- SUS Collaborating Center for Technology Assessment and Excellence in Health (CCATES), Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil
| | - Augusto A. Guerra Júnior
- School of Pharmacy, Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil
- SUS Collaborating Center for Technology Assessment and Excellence in Health (CCATES), Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil
| | | | - Juliana Alvares
- School of Pharmacy, Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil
- SUS Collaborating Center for Technology Assessment and Excellence in Health (CCATES), Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil
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Vargas-Uricoechea H. Efficacy and Safety of Insulin Glargine 300 U/mL versus 100 U/mL in Diabetes Mellitus: A Comprehensive Review of the Literature. J Diabetes Res 2018; 2018:2052101. [PMID: 29619381 PMCID: PMC5830021 DOI: 10.1155/2018/2052101] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/28/2017] [Indexed: 12/15/2022] Open
Abstract
To achieve good metabolic control in diabetes and maintain it in the long term, a combination of changes in lifestyle and pharmacological treatment is necessary. The need for insulin depends upon the balance between insulin secretion and insulin resistance. Insulin is considered the most effective glucose-lowering therapy available and is required by people with type 1 diabetes mellitus to control their blood glucose levels; yet, many people with type 2 diabetes mellitus will also eventually require insulin therapy, due to the progressive nature of the disease. A variety of long-acting insulins is currently used for basal insulin therapy (such as insulin glargine, degludec, and detemir), each having sufficient pharmacodynamic and pharmacokinetic profiles to afford lower intrapatient variability and an extended duration of action. The new glargine-300 formulation was developed to have a flatter and more extended time-action profile than the original glargine-100, and these characteristics may translate into more stable and sustained glycemic control over a 24 h dosing interval. The objective of this comprehensive review was to summarize the available evidence on the clinical efficacy and safety of glargine-300 versus glargine-100 from the EDITION clinical trial program, in patients with type 1 and type 2 diabetes mellitus.
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Affiliation(s)
- Hernando Vargas-Uricoechea
- Metabolic Diseases Study Group, Division of Endocrinology and Metabolism, Department of Internal Medicine, Universidad del Cauca, Popayán, Cauca, Colombia
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Abstract
BACKGROUND As the first once-daily basal insulin analog, insulin glargine 100 U/mL (Gla-100; Lantus®) rapidly evolved into the most commonly prescribed insulin therapy worldwide. However, this insulin has clinical limitations. The approval of new basal insulin analogs in 2015 has already started to alter the prescribing landscape. OBJECTIVE To review the available evidence on the clinical efficacy and safety of a more concentrated insulin glargine (recombinant DNA origin) injection 300 U/mL (Gla-300) compared to insulin Gla-100 in patients with type 1 and type 2 diabetes mellitus (T1DM and T2DM). METHODS The following electronic databases were searched: PubMed and MEDLINE (using Ovid platform), Scopus, BIOSIS, and Google Scholar through June 2016. Conference proceedings of the American Diabetes Association (2015-2016) were reviewed. We also manually searched reference lists of pertinent reviews and trials. RESULTS A total of 6 pivotal Phase III randomized controlled trials known as the EDITION series were reviewed. All of these trials (n=3,500) were head-to-head comparisons evaluating the efficacy and tolerability of Gla-300 vs Gla-100 in a diverse population with T1DM and T2DM. These trials were of 6 months duration with a 6-month safety extension phase. CONCLUSION Gla-300 was as effective as Gla-100 for improving glycemic control over 6 months in all studies, with a lower risk of nocturnal hypoglycemia significant only in insulin-experienced patients with T2DM. Overall, patients on Gla-300 required 10%-18% more basal insulin, but with less weight gain compared with Gla-100.
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Affiliation(s)
- Fei Wang
- Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, CT, USA
| | - Stefanie Zassman
- Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, CT, USA
| | - Philip A Goldberg
- Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, New Haven, CT, USA
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Abstract
INTRODUCTION Insulin therapy plays a critical role in the treatment of type 1 and type 2 diabetes mellitus. However, there is still a need to find basal insulins with 24-hour coverage and reduced risk of hypoglycemia. Additionally, with increasing obesity and insulin resistance, the ability to provide clinically necessary high doses of insulin at low volume is also needed. AREAS COVERED This review highlights the published reports of the pharmacokinetic (PK) and glucodynamic properties of concentrated insulins: Humulin-R U500, insulin degludec U200, and insulin glargine U300, describes the clinical efficacy, risk of hypoglycemic, and metabolic changes observed, and finally, discusses observations about the complexity of introducing a new generation of concentrated insulins to the therapeutic market. CONCLUSION Humulin-R U500 has a similar onset but longer duration of action compared with U100 regular insulin. Insulin glargine U300 has differential PK/pharmacodynamic effects when compared with insulin glargine U100. In noninferiority studies, glycemic control with degludec U200 and glargine U300 is similar to insulin glargine U100 and nocturnal hypoglycemia is reduced. Concentrated formulations appear to behave as separate molecular entities when compared with earlier U100 insulin analog compounds. In the review of available published data, newer concentrated basal insulins may offer an advantage in terms of reduced intraindividual variability as well as reducing the injection burden in individuals requiring high-dose and large volume insulin therapy. Understanding the PK and pharmacodynamic properties of this new generation of insulins is critical to safe dosing, dispensing, and administration.
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Affiliation(s)
- Elizabeth M Lamos
- Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lisa M Younk
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stephen N Davis
- Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
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13
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Levin P, Wei W, Miao R, Ye F, Xie L, Baser O, Gill J. Therapeutically interchangeable? A study of real-world outcomes associated with switching basal insulin analogues among US patients with type 2 diabetes mellitus using electronic medical records data. Diabetes Obes Metab 2015; 17:245-53. [PMID: 25359227 PMCID: PMC4383352 DOI: 10.1111/dom.12407] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/03/2014] [Accepted: 10/20/2014] [Indexed: 11/29/2022]
Abstract
AIMS To evaluate real-world clinical outcomes for switching basal insulin analogues [insulin glargine (GLA) and insulin detemir (DET)] among US patients with type 2 diabetes mellitus (T2DM). METHODS Using the GE Centricity Electronic Medical Records database, this retrospective study examined two cohorts: cohort 1, comprising patients previously on GLA and then either switching to DET (DET-S) or continuing with GLA (GLA-C); and cohort 2, comprising patients previously on DET and then either switching to GLA (GLA-S) or continuing with DET (DET-C). Within each cohort, treatment groups were propensity-score-matched on baseline characteristics. At 1-year follow-up, insulin treatment patterns, glycated haemoglobin (HbA1c) levels, hypoglycaemic events, weight and body mass index (BMI) were evaluated. RESULTS The analysis included 13 942 patients: cohort 1: n = 10 657 (DET-S, n = 1797 matched to GLA-C, n = 8860) and cohort 2: n = 3285 (GLA-S, n = 858 matched to DET-C, n = 2427). Baseline characteristics were similar between the treatment groups in each cohort. At 1-year follow-up, in cohort 1, patients in the DET-S subgroup were significantly less persistent with treatment, more likely to use a rapid-acting insulin analogue, had higher HbA1c values, lower HbA1c reductions and lower proportions of patients achieving HbA1c <7.0 or <8.0% compared with patients in the GLA-C subgroup, while hypoglycaemia rates and BMI/weight values and change from baseline were similar in the two subgroups. In cohort 2, overall, there were contrasting findings between patients in the GLA-S and those in the DET-C subgroup. CONCLUSIONS This study showed contrasting results when patients with T2DM switched between basal insulin analogues, although these preliminary results may be subject to limitations in the analysis. Nevertheless, this study calls into question the therapeutic interchangeability of GLA and DET, and this merits further investigation.
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Affiliation(s)
- P Levin
- Model Clinical ResearchBaltimore, MD, USA
- Correspondence to: P. Levin, MODEL Clinical Research, Greater Baltimore Medical Center, 6535 North Charles Street, Suite 400, Baltimore, MD 21204, USA. E-mail:
| | - W Wei
- Sanofi US, Inc.Bridgewater, NJ, USA
| | - R Miao
- Sanofi US, Inc.Bridgewater, NJ, USA
| | - F Ye
- Sanofi US, Inc.Bridgewater, NJ, USA
| | - L Xie
- STATinMED ResearchAnn Arbor, MI, USA
| | - O Baser
- STATinMED ResearchAnn Arbor, MI, USA
- Department of Internal Medicine, University of MichiganAnn Arbor, MI, USA
- School of Economy, MEF UniversityIstanbul, Turkey
| | - J Gill
- Sanofi US, Inc.Bridgewater, NJ, USA
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