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Patel RH, Fan L, Kelly NR, Gelsey F, Hertzberg JK, Brnabic AJM. A machine learning-based algorithm to identify U-500R insulin candidates among adults with type 2 diabetes mellitus in US retrospective databases. Curr Med Res Opin 2024; 40:367-375. [PMID: 38259227 DOI: 10.1080/03007995.2023.2293116] [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: 02/16/2023] [Accepted: 12/06/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To develop a machine learning-based predictive algorithm to identify patients with type 2 diabetes mellitus (T2DM) who are candidates for initiation of U-500R insulin (U-500R). METHODS A retrospective cohort of patients with T2DM was used from a large US administrative claims and electronic health records (EHR) database affiliated with Optum. Predictor variables derived from the data were used to identify appropriate supervised machine learning models including least absolute shrinkage and selection operator (LASSO) and extreme gradient boosted (XGBoost) methods. Predictive performance was assessed using precision-recall (PR) and receiver operating characteristic (ROC) area under the curve (AUC). The clinical interpretation of the final model was supported by fitting the final set of variables from the LASSO and XGBoost models to a traditional logistic regression model. Model choice was determined by comparing Akaike Information Criterion (AIC), residual deviances, and scaled Brier scores. RESULTS Among 81,242 patients who met the study eligibility criteria, 577 initiated U-500R and were assigned to the positive class. Predictors of U-500R initiation included overweight/obesity, neuropathy, HbA1c ≥9% and 8%-9%, BUN 23.8 to <112 mg/dl, ALT 35.9-2056.2 U/L, no radiological chest exams, no GFR labs, and gait/mobility abnormalities. The best performing model was the LASSO model with an ROC AUC of 0.776 on the hold-out test set. CONCLUSION This study successfully developed and validated a machine learning-based algorithm to identify U-500R candidates among patients with T2DM. This may help health care providers and decision-makers to understand important characteristics of patients who could use U-500R therapies which in turn could support policies and guidelines for optimal patient management.
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Affiliation(s)
| | - Ludi Fan
- Eli Lilly and Company, Indianapolis, IN, USA
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2
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Davidson MB. Human Insulin as an Antidote to the High Cost of Insulin: Clinical Insignificance of Pharmacokinetic/Pharmacodynamic Differences. Clin Diabetes 2023; 41:438-441. [PMID: 37456099 PMCID: PMC10338278 DOI: 10.2337/cd22-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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3
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Goldman JD, Angueira-Serrano E, Gonzalez JS, Pang C, Tait J, Edelman S. Survey Reveals Patient and Health Care Provider Experiences and Challenges With the Use of High Doses of Basal Insulin. Clin Diabetes 2022; 41:244-257. [PMID: 37092159 PMCID: PMC10115766 DOI: 10.2337/cd22-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Type 2 diabetes is a chronic, progressive disease, and its management results in a high emotional burden on patients. Eventually many patients require and can benefit from the use of insulin. This article reports results of a survey of patients and health care providers regarding their experiences of and challenges with the use of basal insulin. Health care providers can play a key role in helping people with type 2 diabetes overcome the challenges associated with the use of basal insulin, including connecting with their emotional needs and understanding the stressors associated with managing diabetes.
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Affiliation(s)
- Jennifer D. Goldman
- Massachusetts College of Pharmacy and Health Sciences, Boston, MA
- Well Life Medical, Peabody, MA
| | | | | | | | | | - Steven Edelman
- University of California, San Diego, Veterans Affairs Medical Center, San Diego, CA
- Taking Control of Your Diabetes, La Jolla, CA
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Clinical Utility of Switching to Insulin Degludec From Other Basal Insulins in Adult Patients With Type 1 or 2 Diabetes (SWITCH-IDEG). Can J Diabetes 2021; 46:381-387.e4. [DOI: 10.1016/j.jcjd.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/17/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022]
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Moon S, Chung HS, Kim YJ, Yu JM, Jeong WJ, Park J, Oh CM. Efficacy and Safety of Insulin Degludec/Insulin Aspart Compared with a Conventional Premixed Insulin or Basal Insulin: A Meta-Analysis. Metabolites 2021; 11:metabo11090639. [PMID: 34564455 PMCID: PMC8470485 DOI: 10.3390/metabo11090639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/12/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022] Open
Abstract
Insulin degludec/insulin aspart (IDegAsp) is a novel co-formulation of 70% insulin degludec and 30% insulin aspart. The present meta-analysis was conducted to assess the efficacy and safety of IDegAsp compared with a conventional premixed insulin or basal insulin. We extracted data from citation databases, including PubMed, EMBASE, and the Cochrane Library, since inception to 2021. We calculated the mean differences for hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), self-measured mean glucose, and postprandial glucose (PPG) and odds ratios for confirmed hypoglycemia events. Compared with twice-daily conventional premixed insulin, twice-daily IDegAsp showed a similar effect on changes in HbA1c, but it significantly reduced FPG and self-measured mean glucose levels. Furthermore, compared to once-daily basal insulin, once-daily IDegAsp had a similar effect on changes in HbA1c, but it significantly reduced self-measured mean glucose and PPG levels. The risk of overall confirmed hypoglycemia was similar between treatments; however, the risk of nocturnal hypoglycemia events was significantly lower with IDegAsp than with conventional premixed insulin and basal insulin. Thus, IDegAsp was more effective than conventional premixed insulin and basal insulin at reducing blood glucose with fewer nocturnal hypoglycemia events.
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Affiliation(s)
- Shinje Moon
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon 24252, Korea
| | - Hye-Soo Chung
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon 24252, Korea
| | - Yoon-Jung Kim
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon 24252, Korea
| | - Jae-Myung Yu
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon 24252, Korea
| | - Woo-Ju Jeong
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju 61005, Korea
| | - Jiwon Park
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju 61005, Korea
| | - Chang-Myung Oh
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju 61005, Korea
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6
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Zhang H, Barner JC, Moczygemba LR, Rascati KL. Assessment of basal insulin adherence using 2 methodologies among Texas Medicaid enrollees with type 2 diabetes. J Manag Care Spec Pharm 2020; 26:1434-1444. [PMID: 33119450 PMCID: PMC10390939 DOI: 10.18553/jmcp.2020.26.11.1434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Basal insulin is often recommended as the initial therapy for patients with type 2 diabetes who require insulin treatment. Adequate adherence is critical to diabetes management, yet suboptimal insulin adherence has been reported. Second-generation long-acting (SGLA) insulin has higher dosing flexibility and lower hypoglycemia risk and may improve adherence. However, little is known regarding adherence to SGLA insulin and how adherence to SGLA insulin compares with intermediate-acting neutral protamine Hagedorn (NPH) and first-generation long-acting (FGLA) insulin. Measurement of insulin adherence is challenging because of the inaccuracies of recorded days supply of insulin, and traditional medication possession ratio (MPR) may be negatively affected. Adjusted MPR (aMPR) has been developed in an effort to address this issue. OBJECTIVE: To examine the unadjusted and adjusted associations between basal insulin type and adherence to basal insulin using MPR and aMPR. METHODS: This retrospective database study used Texas Medicaid prescription claims from January 1, 2014, through June 30, 2017. The index date was the date of the first basal insulin prescription without the same prescription 6 months before (pre-index), and all patients were followed for 12 months (post-index). Patients aged 18-63 years with ≥ 1 pre-index prescription of an oral hypoglycemia agent (OHA) or a glucagon-like peptide-1 receptor agonist (GLP-1 RA), without any post-index prescription of premixed insulin or a basal insulin different from index insulin, and with continuous enrollment throughout the pre- and post-index periods, were included. The dependent variable was basal insulin adherence over 12 months, measured using MPR and aMPR. Unadjusted and adjusted adherence comparisons were conducted by basal (background) insulin type (NPH, FGLA, and SGLA). Covariates included age, gender, baseline use of basal insulins and comorbid medications, total number of medications, OHA adherence, post-index number of OHAs, and use of bolus insulins and GLP-1 RAs. Analysis of variance, chi-square tests, and multiple logistic regression analyses were performed. RESULTS: Of the 5,034 patients included, NPH, FGLA, and SGLA insulin users accounted for 3.7%, 89.8%, and 6.5%, respectively. The overall mean (SD) age was 50.9 (9.9) years, and 65.9% were female. In the unadjusted bivariate analyses, SGLA insulin users had significantly higher adherence, using either MPR (SGLA 0.68 [0.25] vs. FGLA 0.59 [0.27] vs. NPH 0.55 [0.27]; P < 0.0001) or aMPR (0.83 [0.23] vs. 0.78 [0.26] vs. 0.73 [0.28]; P = 0.0001). After controlling for covariates, insulin type was not significantly associated with the likelihood of being adherent (MPR or aMPR ≥ 0.8) using either measure. CONCLUSIONS: Adherence to SGLA insulin was not different from adherence to other basal insulins after controlling for patient characteristics. Yet, MPR and aMPR have limitations and warrant further confirmation of the study findings. Before new adherence measures for insulin therapy are developed, MPR and aMPR should be used with caution. DISCLOSURES: No specific funding was received for this manuscript. The authors report no potential conflicts of interest. Part of the data from this study was presented as posters at the American Pharmacists Association 2020 Annual Meeting & Exposition, March 20-23, 2020, in National Harbor, MD, and at the International Society for Pharmacoeconomics and Outcomes Research 2020 Conference, May 16-20, 2020, in Orlando, FL.
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Affiliation(s)
- Hanxi Zhang
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin
| | - Jamie C Barner
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin
| | | | - Karen L Rascati
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin
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Gilor C, Culp W, Ghandi S, do Carmo Emidio E Silva JA, Ladhar A, Hulsebosch SE. Comparison of pharmacodynamics and pharmacokinetics of insulin degludec and insulin glargine 300 U/mL in healthy cats. Domest Anim Endocrinol 2019; 69:19-29. [PMID: 31280022 DOI: 10.1016/j.domaniend.2019.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/16/2019] [Accepted: 04/04/2019] [Indexed: 01/08/2023]
Abstract
Insulin glargine 300 U/mL (IGla-U300) and insulin degludec (IDeg) are synthetic insulin analogs designed as basal insulin formulations. In people, IGla-U300 is more predictable and longer acting compared with glargine 100 U/mL. The duration of action of IDeg in people is > 42 h, allowing flexibility in daily administration. We hypothesized that IDeg would have longer duration of action compared with IGla-U300 in healthy purpose-bred cats. Seven cats received 0.4 U/kg (subcutaneous) of IDeg and IGla-U300 on two different days, >1 wk apart. Exogenous insulin was measured and pharmacodynamic parameters were derived from glucose infusion rates during isoglycemic clamps and suppression of endogenous insulin. The Shapiro-Wilk test was used to assess normality, and normally distributed parameters were compared using paired t-tests. There was no difference between IDeg and IGla-U300 in onset, peak action, or total metabolic effect. On average, time to peak action (TPEAK) of IGla-U300 was 145 ± 114 min (95% confidence interval [CI] = 25-264) longer than TPEAK of IDeg (P = 0.03) and duration of action (TDUR) of IGla-U300 was 250 ± 173 min (95% CI = 68-432) longer than TDUR of IDeg (P = 0.02). The "flatness" of the time-action profile (as represented by the quotient of peak action/TDUR) was significantly greater for IGla-U300 compared with IDeg (P = 0.04). Overall, insulin concentration measurements concurred with findings from isoglycemic clamps. Based on these data, IDeg is not suitable for once-daily administration in cats. The efficacy of once-daily IGla-U300 in diabetic cats should be further investigated.
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Affiliation(s)
- C Gilor
- Department of Veterinary Medicine and Epidemiology, University of California, Davis, 1 Shields Avenue, Davis, CA 95616, USA.
| | - W Culp
- Department of Veterinary Surgical and Radiological Sciences, University of California, Davis, 1 Shields Avenue, Davis, CA 95616, USA
| | - S Ghandi
- Department of Veterinary Medicine and Epidemiology, University of California, Davis, 1 Shields Avenue, Davis, CA 95616, USA
| | - J A do Carmo Emidio E Silva
- Department of Veterinary Clinic and Surgery, UNESP - Univ. Estadual Paulista, Jaboticabal, Via de Acesso Prof. Paulo Donato Castellani, s/n, Jaboticabal, SP 14884-900, Brazil
| | - A Ladhar
- School of Nursing and Health Professions, University of San Francisco, 2130 Fulton Street, San Francisco, CA 94117, USA
| | - S E Hulsebosch
- Department of Veterinary Medicine and Epidemiology, University of California, Davis, 1 Shields Avenue, Davis, CA 95616, USA
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8
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Warren ML, Brod M, Håkan-Bloch J, Sparre T, Chaykin LB. Patient-reported outcomes from a randomized, crossover trial comparing a pen injector with insulin degludec versus a pen injector with insulin glargine U100 in patients with type 2 diabetes. Curr Med Res Opin 2019; 35:1623-1629. [PMID: 30974973 DOI: 10.1080/03007995.2019.1605769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Type 2 diabetes (T2D) is associated with insulin resistance and deteriorated glycemic control that can be restored with insulin injections. Choice of insulin pen injector may affect complexity, adherence, efficacy of treatment and health-related quality of life. We describe detailed patient-reported outcomes (PROs) on treatment impact and preference comparing insulin degludec (degludec) using FlexTouch1 versus insulin glargine U100 (glargine U100) with SoloStar2 pen injector.Methods: In this randomized, multicenter (USA), open-label, crossover, treat-to-target study (NCT01570751), patients with T2D using high-dose insulin (≥81 U/day from vials) were randomized (n = 145) 1:1 to 16 weeks of degludec U200 (3 mL FlexTouch) followed by 16 weeks of glargine U100 (3 mL SoloStar) or vice versa. PRO questionnaires assessed treatment impact and patient preference of pen injectors.Results: Significantly more patients (p < .01) considered FlexTouch "extremely easy" for learning (62.5 vs. 43.0%), maintaining (63.2 vs. 42.2%) and adjusting the dose (63.2 vs. 44.4%), and significantly more were "very" or "extremely confident" in using the device (60.3 vs. 36.3%) and in its accuracy (50.7 vs. 30.4%) versus SoloStar. Significantly more were "not at all bothered" by device discomfort (74.3 vs. 54.1%), whereas device size (83.8 vs. 80.0%) or public use (69.9 vs. 60.7%) were numerically in favor of FlexTouch. Significantly more patients preferred degludec treatment with FlexTouch (59 vs. 22%), preferred to continue (67 vs. 15%) and recommend (67 vs. 14%) use of FlexTouch compared with SoloStar with glargine U100.Conclusions: In this randomized, crossover trial, lower treatment impact and higher patient preference were reported for FlexTouch versus SoloStar pen injectors.
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Affiliation(s)
| | | | | | - Thomas Sparre
- Medical & Science Devices & Titration, Novo Nordisk A/S, Søborg, Denmark
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9
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Zhou W, Tao J, Zhou X, Chen H. Insulin Degludec, a Novel Ultra-Long-Acting Basal Insulin versus Insulin Glargine for the Management of Type 2 Diabetes: A Systematic Review and Meta-Analysis. Diabetes Ther 2019; 10:835-852. [PMID: 31020539 PMCID: PMC6531575 DOI: 10.1007/s13300-019-0624-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The purpose of this study was to compare insulin degludec with insulin glargine in terms of efficacy and safety in patients with type 2 diabetes. METHODS We systematically searched PubMed, Embase, Web of Science, and Cochrane Library databases for randomized controlled trials published prior to 13 August 2018 (no language restrictions) which compared insulin degludec with insulin glargine. Our main endpoints were glycemic control, hypoglycemic event, weight gain, and serious adverse events (SAEs). We assessed pooled data using random-effects models. RESULTS A total of 15 studies that included 9619 patients in the insulin degludec arm of the studies and 7075 patients in the insulin glargine arm were identified and subsequently assessed. Our analysis showed that compared with insulin glargine, insulin degludec yielded an improved mean reduction in fasting plasma glucose (FPG) (weighted mean difference [WMD] - 5.20 mg/dL, 95% confidence interval [CI] - 7.34, - 3.07, P < 0.00001) and a lower ratio of participants experiencing ≥ 1 severe hypoglycemic event (relative risk [RR] 0.68, 95% CI 0.50, 0.93, P = 0.01) and nocturnal hypoglycemia (RR 0.81, 95% CI 0.75, 0.88, P < 0.0001); however, in the insulin degludec group there was a lower ratio of participants with glycated hemoglobin (HbA1c) of ≤ 7.0% (RR 0.92, 95% CI 0.86, 0.98, P = 0.01). There was no statistically significant difference between the two treatment groups for HbA1c reduction (WMD 0.03, 95% CI - 0.00, 0.07, P = 0.08), body weight gain (WMD 0.12, 95% CI - 0.19, 0.43, P = 0.46), and proportion of participants with SAEs (RR 0.97, 95% CI 0.92, 1.02, P = 0.20). CONCLUSIONS Insulin degludec and insulin glargine provide similar glycemic control, but insulin degludec also lowers the risk of hypoglycemia. Consequently, insulin degludec may be an alternative treatment for the management of patients with type 2 diabetes who are prone to hypoglycemia with insulin glargine.
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Affiliation(s)
- Wenchuan Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng Road, Donghu District, Nanchang, 330006 China
- Department of Clinical Medicine, The Second Clinical Medical College, Nanchang University, Nanchang, China
| | - Jinxin Tao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng Road, Donghu District, Nanchang, 330006 China
- Department of Clinical Medicine, The Second Clinical Medical College, Nanchang University, Nanchang, China
| | - Xiaodong Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng Road, Donghu District, Nanchang, 330006 China
| | - Hongxia Chen
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Holmes RS, Crabtree E, McDonagh MS. Comparative effectiveness and harms of long-acting insulins for type 1 and type 2 diabetes: A systematic review and meta-analysis. Diabetes Obes Metab 2019; 21:984-992. [PMID: 30552792 DOI: 10.1111/dom.13614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/30/2018] [Accepted: 12/13/2018] [Indexed: 12/20/2022]
Abstract
AIM To review evidence comparing benefits and harms of long-acting insulins in patients with type 1 and 2 diabetes. METHODS MEDLINE and two Cochrane databases were searched during February 2018. Two authors selected studies meeting inclusion criteria and assessed their quality. Comparative studies of adult or paediatric patients with diabetes treated with insulin degludec, detemir or glargine were included. Meta-analysis was used to combine results of similar studies, and the I2 statistic calculated to assess statistical heterogeneity. RESULTS Of 2534 citations reviewed, 70 studies met the inclusion criteria. No statistically significant differences in HbA1c were seen between any two insulins or formulations. Hypoglycaemia was less probable with degludec than with glargine, including nocturnal hypoglycaemia in type 1 (rate ratio 0.68, 95% CI 0.56-0.81) and type 2 diabetes (rate ratio 0.73, 95% CI 0.65-0.82), and severe hypoglycaemia in type 2 diabetes (relative risk 0.72, 95% CI 0.54-0.96). Patients with type 2 diabetes had higher rates of withdrawal because of adverse events when treated with detemir compared with glargine (relative risk 2.1, 95% CI 1.4-3.3). Adults taking detemir gained about 1 kg less body weight than those taking degludec (type 1) or glargine (type 2). CONCLUSIONS No differences in glycaemic control were seen between insulin degludec, detemir and glargine. Hypoglycaemia was less probable with degludec than glargine, and patients taking detemir gained less body weight than those given degludec or glargine. In type 2 diabetes, withdrawals as a result of adverse events were more probable with detemir than glargine.
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Affiliation(s)
- Rebecca S Holmes
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Elizabeth Crabtree
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Marian S McDonagh
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon
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Chaykin L, Bhargava A, de la Rosa R, Wysham CH, Nørgård Troelsen L, Østoft SH, Philis-Tsimikas A. Effect of Insulin Degludec Versus Insulin Glargine U100 on Hypoglycemia in Hispanic Patients With Type 2 Diabetes: Results From the SWITCH 2 Trial. Clin Diabetes 2019; 37:73-81. [PMID: 30705500 PMCID: PMC6336128 DOI: 10.2337/cd18-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
IN BRIEF Hispanic patients with type 2 diabetes have poorer glycemic control and are at higher risk of severe diabetes complications and mortality than non-Hispanic white patients. This post hoc analysis investigated the safety and efficacy of insulin degludec versus insulin glargine 100 units/mL (glargine U100) in the Hispanic patient subpopulation from the SWITCH 2 trial. In Hispanic patients, hypoglycemia was consistently lower and nocturnal hypoglycemia was significantly lower with degludec versus glargine U100 at similar levels of glycemic control. Overall, results in Hispanic patients in SWITCH 2 were consistent with those in non-Hispanic patients.
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Affiliation(s)
| | - Anuj Bhargava
- Iowa Diabetes and Endocrinology Research Center, Des Moines, IA
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Madenidou AV, Paschos P, Karagiannis T, Katsoula A, Athanasiadou E, Kitsios K, Bekiari E, Matthews DR, Tsapas A. Comparative Benefits and Harms of Basal Insulin Analogues for Type 2 Diabetes: A Systematic Review and Network Meta-analysis. Ann Intern Med 2018; 169:165-174. [PMID: 29987326 DOI: 10.7326/m18-0443] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Basal insulin analogues aim for protracted glycemic control with minimal adverse effects. PURPOSE To assess the comparative efficacy and safety of basal insulin analogues for adults with type 2 diabetes mellitus (T2DM). DATA SOURCES Several databases from inception to April 2018 without language restrictions, ClinicalTrials.gov to April 2018, references of reviews, and meeting abstract books. STUDY SELECTION Randomized trials lasting at least 12 weeks that compared efficacy (change in hemoglobin A1c [HbA1c] level from baseline [primary outcome]; percentage of patients with HbA1c level <7% at end of study and change in body weight [secondary outcomes]) and safety (hypoglycemia) of basal insulin analogues. DATA EXTRACTION Two authors independently extracted data and assessed risk of bias for each outcome. All authors evaluated overall confidence in the evidence. DATA SYNTHESIS Thirty-nine trials (26 195 patients) assessed 10 basal insulin analogues. Low- to very-low-quality evidence indicated that thrice-weekly degludec (Deg-3TW) was inferior to most other regimens for reducing HbA1c level, with mean differences ranging from 0.21% (vs. degludec, 100 U/mL [Deg-100]) to 0.32% (vs. glargine, 300 U/mL [Glar-300]). High- to moderate-quality evidence suggested that detemir had a favorable weight profile versus all comparators, and Glar-300 was associated with less weight gain than glargine, 100 U/mL (Glar-100); Deg-100; degludec, 200 U/mL (Deg-200); Deg-3TW; and LY2963016. Low- and very-low-quality evidence suggested that Deg-100, Deg-200, and Glar-300 were associated with lower incidence of nocturnal hypoglycemia than detemir, Glar-100, LY2963016, and neutral protamine lispro (NPL). Incidence of severe hypoglycemia did not differ among regimens, except NPL, which was associated with increased risk versus Deg-100, detemir, Glar-100, and Glar-300. LIMITATIONS Results are based mostly on indirect comparisons. Confidence in summary estimates is low or very low due to individual-study limitations, imprecision, or inconsistency. CONCLUSION Low-quality evidence suggests that basal insulin analogues for T2DM do not substantially differ in their glucose-lowering effect. Low- and very-low-quality evidence suggests some regimens may be associated with lower risk for nocturnal hypoglycemia (Deg-100, Deg-200, and Glar-300) or less weight gain (detemir and Glar-300). PRIMARY FUNDING SOURCE None. (PROSPERO: CRD42016037055).
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Affiliation(s)
| | - Paschalis Paschos
- Aristotle University of Thessaloniki, Thessaloniki, Greece (A.M., P.P., T.K., A.K., E.A., K.K., E.B.)
| | - Thomas Karagiannis
- Aristotle University of Thessaloniki, Thessaloniki, Greece (A.M., P.P., T.K., A.K., E.A., K.K., E.B.)
| | - Anastasia Katsoula
- Aristotle University of Thessaloniki, Thessaloniki, Greece (A.M., P.P., T.K., A.K., E.A., K.K., E.B.)
| | - Eleni Athanasiadou
- Aristotle University of Thessaloniki, Thessaloniki, Greece (A.M., P.P., T.K., A.K., E.A., K.K., E.B.)
| | - Konstantinos Kitsios
- Aristotle University of Thessaloniki, Thessaloniki, Greece (A.M., P.P., T.K., A.K., E.A., K.K., E.B.)
| | - Eleni Bekiari
- Aristotle University of Thessaloniki, Thessaloniki, Greece (A.M., P.P., T.K., A.K., E.A., K.K., E.B.)
| | | | - Apostolos Tsapas
- Aristotle University of Thessaloniki, Thessaloniki, Greece, and University of Oxford, Oxford, United Kingdom (A.T.)
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Ovalle F, Segal AR, Anderson JE, Cohen MR, Morwick TM, Jackson JA. Understanding concentrated insulins: a systematic review of randomized controlled trials. Curr Med Res Opin 2018; 34:1029-1043. [PMID: 29166786 DOI: 10.1080/03007995.2017.1409426] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compile, analyze, and summarize the literature on concentrated insulins (i.e. concentrations >100 units/mL) from randomized controlled trials and derive guidance on appropriate use of these agents. METHODS Searches were conducted in Medline, Embase, the Cochrane Central Register of Controlled Trials, Trialtrove (through April 2016) and ClinicalTrials.gov (through April 2017) for phase 1-4 clinical studies using concentrated insulins. Selected studies included multiple-arm, randomized controlled trials evaluating subcutaneously administered concentrated insulins. Trial registration numbers (selected studies) were searched in Medline, Embase and Google Scholar (through April 2017). Late-phase studies were graded using guidance from the Agency for Healthcare Research and Quality. RESULTS Thirty-eight completed trials (7900 participants) and 34 qualifying publications were identified. Four marketed concentrated insulins were evaluated: two long-acting basal (insulin glargine 300 units/mL and insulin degludec 200 units/mL [IDeg200]), one rapid-acting prandial (insulin lispro 200 units/mL [ILis200]), and one prandial/basal (human regular insulin 500 units/mL). Early-phase trials established bioequivalence for IDeg200 and ILis200 with the corresponding 100 units/mL formulations. Efficacy studies showed noninferior glycemic control between comparators for long-acting basal and prandial/basal products with generally low severe hypoglycemia. Six additional concentrated insulins with completed early-phase development were also identified. CONCLUSION Concentrated-insulin products demonstrated efficacious and safe outcomes in appropriate patients. Clinical findings (HbA1c and hypoglycemia) and methodology (initiation and titration), patient factors (insulin experience and dosing requirements) and treatment characteristics (bioequivalence, potency and device features) are important considerations. This overview of these and other factors provides essential information and guidance for using concentrated insulins in clinical practice.
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Affiliation(s)
- Fernando Ovalle
- a Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Alissa R Segal
- b Department of Pharmacy Practice, School of Pharmacy , MCPHS University , Boston , MA , USA
- c Joslin Diabetes Center , Boston , MA , USA
| | | | - Michael R Cohen
- e Institute for Safe Medication Practices , Horsham , PA , USA
| | - Tina M Morwick
- f Lilly Diabetes, Eli Lilly and Company , Indianapolis , IN , USA
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Liu W, Yang X, Huang J. Efficacy and Safety of Insulin Degludec versus Insulin Glargine: A Systematic Review and Meta-Analysis of Fifteen Clinical Trials. Int J Endocrinol 2018; 2018:8726046. [PMID: 29721018 PMCID: PMC5867587 DOI: 10.1155/2018/8726046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/17/2017] [Accepted: 01/01/2018] [Indexed: 11/17/2022] Open
Abstract
AIMS Insulin degludec (IDeg) and insulin glargine (IGlar) are both proved to be effective in diabetes. This study aimed to assess the effects and safety of IDeg versus IGlar. METHODS A systematic literature search was conducted using the PubMed, EMBASE, and Cochrane Library electronic databases to identify all randomized controlled trials (RCTs). RESULTS Fifteen RCTs were identified. The combined data showed that the decrease in the glycosylated hemoglobin (HbA1c) level was slightly different, and the proportion of patients who achieved HbA1c < 7% was similar between the IDeg and IGlar groups. Further, a statistically significant decrease in the fasting plasma glucose level was observed in the IDeg group as compared to the IGlar group. In patients with T2DM, IDeg was associated with lower rates of overall hypoglycemia. Nocturnal hypoglycemia was significantly lower in the case of IDeg than in the case of IGlar in both T1DM and T2DM patients. No statistically significant differences were observed between the groups. CONCLUSIONS Compared with IGlar, IDeg is associated with equivalent glycemic control and a statistically significantly lower rate of nocturnal hypoglycemia in patients with T1DM and T2DM. In T2DM patients, IDeg also provides better results in terms of overall hypoglycemia.
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Affiliation(s)
- Wei Liu
- Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Xiaojie Yang
- Department of Endocrinology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Jing Huang
- Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang, China
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Brusko CSA, Taylor AD, Jackson JA, Bunck MC. Clinical Challenges With Concentrated Insulins: Setting the Record Straight. Diabetes Spectr 2017; 30:229-232. [PMID: 29151710 PMCID: PMC5687105 DOI: 10.2337/ds17-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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