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Brøsen JMB, Agesen RM, Alibegovic AC, Ullits Andersen H, Beck-Nielsen H, Gustenhoff P, Krarup Hansen T, Hedetoft CGR, Jensen TJ, Stolberg CR, Bogh Juhl C, Lerche SS, Nørgaard K, Parving HH, Tarnow L, Thorsteinsson B, Pedersen-Bjergaard U. Continuous Glucose Monitoring-Recorded Hypoglycemia with Insulin Degludec or Insulin Glargine U100 in People with Type 1 Diabetes Prone to Nocturnal Severe Hypoglycemia. Diabetes Technol Ther 2022; 24:643-654. [PMID: 35467938 DOI: 10.1089/dia.2021.0567] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background and Aims: Nocturnal hypoglycemia is mainly a consequence of inappropriate basal insulin therapy in type 1 diabetes (T1D) and may compromise optimal glycemic control. Insulin degludec is associated with a lower risk of nocturnal hypoglycemia in T1D. As nocturnal hypoglycemia is often asymptomatic, we applied continuous glucose monitoring (CGM) to detect a more precise occurrence of nocturnal hypoglycemia in the HypoDeg trial, comparing insulin degludec with insulin glargine U100 in people with T1D and previous nocturnal severe hypoglycemia. Materials and Methods: In the HypoDeg trial, 149 people with T1D were included in an open-label randomized cross-over trial. Sixty-seven participants accepted optional participation in the predefined substudy of 4 × 6 days of blinded CGM requiring completion of at least one CGM period in each treatment arm. CGM data were reviewed for hypoglycemic events. Results: Treatment with insulin degludec resulted in a relative rate reduction (RRR) of 36% (95% confidence interval [CI]: 10%-54%; P < 0.05) in nocturnal CGM-recorded hypoglycemia (≤3.9 mmol/L), corresponding to an absolute rate reduction (ARR) of 0.85 events per person-week. In nocturnal CGM-recorded hypoglycemia (≤3.0 mmol/L), we found an RRR of 53% (95% CI: 36%-65%; P < 0.001), corresponding to an ARR of 0.75 events per person-week. At the lower detection limit of the CGM (≤2.2 mmol/L), treatment with insulin degludec resulted in a significant RRR of 58% (95% CI: 23%-77%; P = 0.005). The reductions were primarily due to significant RRRs in asymptomatic hypoglycemia. Conclusion: In people with T1D, prone to nocturnal severe hypoglycemia, insulin degludec compared with insulin glargine U100 significantly reduces nocturnal CGM-recorded hypoglycemia. www.clinicaltrials.gov (#NCT02192450).
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Affiliation(s)
- Julie Maria Bøggild Brøsen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical & Sciences, University of Copenhagen, Denmark
| | - Rikke Mette Agesen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical & Sciences, University of Copenhagen, Denmark
- Department of Medical & Science, Novo Nordisk A/S, Søborg, Denmark
| | - Amra Ciric Alibegovic
- Department of Medical & Science, Novo Nordisk A/S, Søborg, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Henrik Ullits Andersen
- Department of Clinical Medicine, Faculty of Health and Medical & Sciences, University of Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Henning Beck-Nielsen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Regional Health Research, Faculty of Health and Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Troels Krarup Hansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus, Denmark
| | | | - Tonny Joran Jensen
- Department of Clinical Medicine, Faculty of Health and Medical & Sciences, University of Copenhagen, Denmark
- Department of Medical Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Røn Stolberg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Medicine, University Hospital South West Jutland, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Claus Bogh Juhl
- Department of Medicine, University Hospital South West Jutland, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense, Denmark
| | | | - Kirsten Nørgaard
- Department of Clinical Medicine, Faculty of Health and Medical & Sciences, University of Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Endocrinology, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Hans-Henrik Parving
- Department of Clinical Medicine, Faculty of Health and Medical & Sciences, University of Copenhagen, Denmark
- Department of Medical Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lise Tarnow
- Department of Clinical Research, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Steno Diabetes Center Zealand, Holbæk, Denmark
| | - Birger Thorsteinsson
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical & Sciences, University of Copenhagen, Denmark
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical & Sciences, University of Copenhagen, Denmark
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