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Charleer S, Fieuws S, De Block C, Bolsens N, Nobels F, Mikkelsen K, Mathieu C, Gillard P. Evaluation of Glucose Metrics in Adults with Type 1 Diabetes Switching to Insulin Glargine 300 U/mL: A Retrospective, Propensity-Score Matched Study. Diabetes Technol Ther 2024. [PMID: 38386438 DOI: 10.1089/dia.2023.0371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Objectives: To study real-world effect of switching to Insulin Glargine 300 U/mL (Gla-300) on glucose metrics in people with type 1 diabetes. Methods: This retrospective secondary-use study compared 151 adults who switched to Gla-300 from first-generation long-acting insulins (Switchers) to 281 propensity-score matched controls (Non-switchers) who continued first-generation long-acting insulins. Primary endpoint was difference in time in range (TIR) evolution. A fictive "switching" date was assigned to Non-switchers to facilitate between-group comparisons. Results: In the period before switching, TIR decreased numerically for people in whom Gla-300 was eventually initiated (-0.05%/month [-0.16 to 0.07]), while it increased for matched controls (0.08%/month [0.02 to 0.015]; between-group difference P = 0.047). After Gla-300-initiation, Switchers had similar TIR increase compared to Non-switchers (P = 0.531). Switchers used higher basal dose than before switch (Δ0.012 U/[kg·d] [0.006 to 0.018]; P < 0.0001). Conclusion: In real-life, Gla-300 was typically initiated in people where TIR was decreasing, which was reversed after switch using slightly higher basal insulin dose. ClinicalTrials: ClinicalTrials.gov number NCT05109520.
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Affiliation(s)
- Sara Charleer
- Department of Endocrinology, University Hospitals Leuven-KU Leuven, Leuven, Belgium
| | - Steffen Fieuws
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven and University of Hasselt, Leuven, Belgium
| | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, University Hospital Antwerp - University of Antwerp, Antwerp, Belgium
| | - Nancy Bolsens
- Department of Endocrinology-Diabetology-Metabolism, University Hospital Antwerp - University of Antwerp, Antwerp, Belgium
| | - Frank Nobels
- Department of Endocrinology, OLV Hospital Aalst, Aalst, Belgium
| | | | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven-KU Leuven, Leuven, Belgium
| | - Pieter Gillard
- Department of Endocrinology, University Hospitals Leuven-KU Leuven, Leuven, Belgium
- Fonds Wetenschappelijk Onderzoek (FWO), Brussels, Belgium
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2
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Hasebe M, Satoh S, Ito K, Tamura H, Terauchi Y. Endocrinological evaluation of dawn phenomenon in patients with diabetes and comparison of insulin glargine U-100 biosimilar (Insulin Glargine BS Injection "Lilly") and glargine U-300 (Lantus XR): a randomized controlled study. Endocr J 2023; 70:777-786. [PMID: 37164694 DOI: 10.1507/endocrj.ej22-0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/12/2023] Open
Abstract
We investigated the pathophysiology of the dawn phenomenon by examining the effects of changes in blood glucose levels from late night to early morning on various hormones in a group taking glargine BS and a group taking Lantus XR, with the goal of achieving better glycemic control. Patients with types 1 and 2 diabetes scheduled for inpatient education were divided into BS and XR groups. Blood glucose levels were tracked from 0:00 to 7:00, while blood samples were extracted at 3:00 and 7:00 to measure glucose levels and hormones related to the dawn phenomenon. Overall, we analyzed blood sample and intermittently scanned Continuous Glucose Monitoring data of 43 and 40 patients, respectively. From 0:00 to 7:00, the mean blood glucose was significantly lower in the BS group, although the fluctuation was similar (p < 0.0001). The BS group also exhibited significantly higher ∆ACTH (p = 0.0215) and ∆ cortisol (p = 0.0430) than the XR group. In the BS group, ∆Glu exhibited a significant negative correlation with ∆ACTH and ∆cortisol (p = 0.0491). Similar findings were not observed in the XR group. These results suggest that XR may be a better choice for long-acting insulin since it is less likely to induce cortisol secretion. Further, analysis of the dawn phenomenon and non-dawn phenomenon groups showed the mean CPR levels at 3:00 and 7:00 were significantly higher in the latter (p = 0.0135). This supports the conventional belief that appropriate basal insulin replacement therapy is a beneficial treatment for the dawn phenomenon.
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Affiliation(s)
- Masanori Hasebe
- Metabolism Internal Secretion Internal Medicine, Chigasaki Municipal Hospital, Kanagawa 253-0042, Japan
- Endocrinology/Diabetes and Metabolism, Yokohama City University Hospital, Kanagawa 236-0004, Japan
| | - Shinobu Satoh
- Metabolism Internal Secretion Internal Medicine, Chigasaki Municipal Hospital, Kanagawa 253-0042, Japan
| | - Kohei Ito
- Metabolism Internal Secretion Internal Medicine, Chigasaki Municipal Hospital, Kanagawa 253-0042, Japan
| | - Haruka Tamura
- Metabolism Internal Secretion Internal Medicine, Chigasaki Municipal Hospital, Kanagawa 253-0042, Japan
| | - Yasuo Terauchi
- Endocrinology/Diabetes and Metabolism, Yokohama City University Hospital, Kanagawa 236-0004, Japan
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3
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Yang CT, Yao WY, Ou HT, Kuo S. Value of GLP-1 receptor agonists versus long-acting insulins for type 2 diabetes patients with and without established cardiovascular or chronic kidney diseases: A model-based cost-effectiveness analysis using real-world data. Diabetes Res Clin Pract 2023; 198:110625. [PMID: 36924833 DOI: 10.1016/j.diabres.2023.110625] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 01/31/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023]
Abstract
AIMS To evaluate the cost-effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1RAs) versus long-acting insulins (LAIs) in patients with type 2 diabetes (T2D) using real-world data. METHODS A Markov model was utilized to estimate healthcare costs (US$) and quality-adjusted life-years (QALYs) of receiving treatments over 10 years from the healthcare sector perspective. Model inputs were derived from the analyses of Taiwan's National Health Insurance Research Database or published literature on Taiwanese T2D populations. Base-case analysis was performed for the overall study cohort and subgroup analyses were stratified by the presence or absence of established cardiovascular diseases (CVDs) or chronic kidney diseases (CKDs). RESULTS Overall, using GLP-1RAs versus LAIs cost $6,053 per QALY gained. Results were robust across sensitivity and scenario analyses. Among patients with established CVDs and CKDs, GLP-1RA versus LAI therapy saved $673 (cost-saving) and cost $1,675 per QALY gained, respectively. Among patients without established CVDs and CKDs, GLP-1RA versus LAI therapy cost $9,093 and $7,659 per QALY gained, respectively. CONCLUSIONS Using GLP-1RAs versus LAIs for T2D patients represented good economic value in real-world practice. Pronounced economic benefits of GLP-1RA therapy among those with prior CVDs or CKDs support rational treatment decisions and optimal healthcare resource allocation for these patients.
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Affiliation(s)
- Chun-Ting Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Yu Yao
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huang-Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Shihchen Kuo
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
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4
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Iwamoto M, Nakanishi S, Iwamoto H, Kaneto H, Maegawa H. Clinical course of different long-acting insulin therapies-glargine U100, U300, degludec, and insulin degludec/insulin aspart-among Japanese patients with type 2 diabetes: a multicenter retrospective observational study (JDDM65 study). Endocr J 2022; 69:763-771. [PMID: 35082188 DOI: 10.1507/endocrj.ej21-0647] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/23/2022] Open
Abstract
This study aimed to retrospectively compare the clinical efficacy of different types of long-acting insulin therapies-glargine U100, glargine U300, degludec, and insulin degludec/insulin aspart-among Japanese patients with type 2 diabetes after insulin use was initiated in an outpatient setting. The study consisted of 822 insulin-naïve patients in Japan who started using long-acting insulin for treatment of type 2 diabetes and continued for over 12 months. In addition, the impact of insulin type on insulin withdrawal was investigated by dividing the participants into two groups: those who achieved insulin withdrawal and those who did not, during the 12-month observation period based on a Cox proportional hazards model. As a result, HbA1c was decreased, and BMI was increased in all participants regardless of the insulin type used. A total of 185 participants succeeded in insulin withdrawal. After adjustment was made for several confounders, the positive determinant factors for withdrawal were short duration of diabetes and the choice of IDegAsp when compared with Gla100; the negative determinant factor was use of insulin secretagogues at the start of the study. In conclusion, all long-acting insulins were a powerful tool for treatment of type 2 diabetes, and patients with short duration of diabetes and/or no usage of insulin secretagogues resulted in favorable outcomes in terms of insulin withdrawal within a year in an outpatient setting. In addition, insulin degludec/insulin aspart was found to possibly be a better choice for treatment when it was compared with glargine U100 among the four types of insulin.
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Affiliation(s)
| | - Shuhei Nakanishi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Okayama, Japan
| | - Hideyuki Iwamoto
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Okayama, Japan
| | - Hideaki Kaneto
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, Okayama, Japan
| | - Hiroshi Maegawa
- Department of Medicine, Division of Diabetology, Endocrinology, and Nephrology, Shiga University of Medical Science, Shiga, Japan
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5
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Ito K, Satoh S, Kondo Y, Tamura H, Hasebe M, Terauchi Y. Effect of dulaglutide and long-acting insulin combination therapy in patients with type 2 diabetes: a retrospective observational study. Diabetol Int 2022; 14:51-57. [PMID: 36636162 PMCID: PMC9829941 DOI: 10.1007/s13340-022-00592-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/15/2022] [Indexed: 01/16/2023]
Abstract
Objective The study aimed to evaluate the long-term effects of combination therapy comprising dulaglutide and long-acting insulin, on glycemic control in patients with type 2 diabetes. Methods This retrospective observational study included 20 patients with type 2 diabetes who underwent blood glucose management with intensive insulin therapy for a limited period. All patients were switched from intensive insulin therapy to combination therapy comprising dulaglutide and long-acting insulin. Hemoglobin A1c was evaluated before and 4, 12, and 24 weeks after starting combination therapy. Continuous glucose monitoring was conducted before and 1 and 24 weeks after starting combination therapy. Results Hemoglobin A1c levels were significantly reduced after 4, 12, and 24 weeks of combination therapy (- 2.2% ± 0.4%, P < 0.0001; - 3.7% ± 0.8%, P = 0.0003; and - 3.6% ± 0.8%, P = 0.0005, respectively). Glycemic variability (% coefficient of variation) was significantly decreased after 1 and 24 weeks of combination therapy (- 5.7% ± 2.1%, P = 0.011; and - 8.7% ± 2.4%, P = 0.003, respectively) and the percentage of readings and time > 250 mg/dL at 24 weeks was significantly improved (- 2.2% ± 0.8%, P = 0.019). Conclusion Combination therapy with dulaglutide and long-acting insulin resulted in better blood glucose control than intensive insulin therapy, which persisted for 24 weeks. Combination therapy also reduced blood glucose fluctuations and the number of self-injections needed. Supplementary Information The online version contains supplementary material available at 10.1007/s13340-022-00592-z.
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Affiliation(s)
- Kohei Ito
- Chigasaki Municipal Hospital, Chigasaki, 253-0042 Japan
| | - Shinobu Satoh
- Chigasaki Municipal Hospital, Chigasaki, 253-0042 Japan
| | - Yoshinobu Kondo
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama, Japan
| | - Haruka Tamura
- Chigasaki Municipal Hospital, Chigasaki, 253-0042 Japan
| | | | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Disotuar MM, Smith JA, Li J, Alam S, Lin NP, Chou DH. Facile synthesis of insulin fusion derivatives through sortase A ligation. Acta Pharm Sin B 2021; 11:2719-25. [PMID: 34589392 DOI: 10.1016/j.apsb.2020.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/29/2020] [Accepted: 11/12/2020] [Indexed: 11/22/2022] Open
Abstract
Insulin derivatives such as insulin detemir and insulin degludec are U.S. Food and Drug Administration (FDA)-approved long-acting insulin currently used by millions of people with diabetes. These derivatives are modified in C-terminal B29 lysine to retain insulin bioactivity. New and efficient methods for facile synthesis of insulin derivatives may lead to new discovery of therapeutic insulin. Herein, we report a new method using sortase A (SrtA)-mediated ligation for the synthesis of insulin derivatives with high efficiency and functional group tolerance in the C-terminal B chain. This new insulin molecule (Ins-SA) with an SrtA-recognizing motif can be conjugated to diverse groups with N-terminal oligoglycines to generate new insulin derivatives. We further demonstrated that a new insulin derivative synthesized by this SrtA-mediated ligation shows strong cellular and in vivo bioactivity. This enzymatic method can therefore be used for future insulin design and development.
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Key Words
- Alb, albumin
- Albumin-binding peptide SA21
- Boc, tert-butyloxycarbonyl
- DCM, dichloromethane
- DIEA, N,N-diisopropylethylamine
- DMEM, Dulbecco's Modified Eagle Medium
- DMF, dimethylformamide
- DMSO, dimethyl sulfoxide
- DOI, desoctapeptide (B23−30) insulin
- Diabetes mellitus
- EDT, 1,2-ethanedithiol
- FBS, fetal bovine serum
- Fmoc, 9-fluorenylmethoxycarbonyl
- HATU, 1-[bis(dimethylamino)methylene]-1H-1,2,3-triazolo[4,5-b]pyridinium 3-oxid hexafluorophosphate
- HBTU, O-(benxontriazol-1-yl)-1,1,3,3-tetramethyluronium
- HPLC, high performance liquid chromatography
- HTRF, homogeneous time resolved fluorescence
- IR-B, human insulin receptor isoform B
- ITT, insulin tolerance test
- Insulin synthesis
- LC‒MS, liquid chromatography mass spectrometry
- Long-acting insulin
- Mtt, 4-methyltrityl
- NBD-X, 6-(N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)amino)hexanoic acid
- STZ, streptozotocin
- Sortase A (SrtA) ligation
- SrtA, sortase A
- THF, triflouroacetic acid
- TIS, triisoproylsilane
- i.p., intraperitoneal
- pAkt, phosphorylated protein kinase B
- t-Bu, tert-butyl
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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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Thalange N, Biester T, Danne T. Clinical Use of Degludec in Children and Adolescents with T1D: A Narrative Review with Fictionalized Case Reports. Diabetes Ther 2019; 10:1219-1237. [PMID: 31187420 PMCID: PMC6612349 DOI: 10.1007/s13300-019-0641-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Indexed: 12/11/2022] Open
Abstract
The use of insulin in children and adolescents with type 1 diabetes (T1D) is a challenge because of the heterogeneity of these patients and their lifestyles, with consequent unpredictability in blood glucose levels. A new ultra-long-acting basal insulin, insulin degludec (degludec), has the potential to mitigate some of these challenges, notably variability in the glucose-lowering action of the basal insulin component of an insulin regimen, and consequent risks of hypo- and hyperglycemia. However, the protracted half-life and steady state pharmacokinetics of degludec potentially bring some new challenges. In particular, the adjustment of therapy in response to commonly encountered clinical situations might require a different approach when degludec is used in place of other currently used basal insulins in this challenging patient population. The purpose of this article is to guide clinicians through a series of case histories in the use of this insulin. These include, but are not limited to, how to initiate, titrate, switch from other basal insulin or pump therapy; how to alleviate difficulties arising as a result of unpredictable lifestyle/habits; and how to maintain treatment following diabetic ketoacidosis. The guidance presented in this review illustrates that degludec is a good option for a diverse range of children and adolescents with T1D, providing much needed flexibility in the treatment of this challenging patient population.Funding Novo Nordisk.
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Affiliation(s)
- Nandu Thalange
- Al Jalila Children's Specialty Hospital, Al Jaddaf, Dubai, United Arab Emirates.
| | - Torben Biester
- Diabetes Centre for Children and Adolescents, AUF DER BULT, Hannover, Germany
| | - Thomas Danne
- Diabetes Centre for Children and Adolescents, AUF DER BULT, Hannover, Germany
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9
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Tentolouris N, Knudsen ST, Lapolla A, Wolden ML, Haldrup S, Schultes B. Switching "Real-World" Diabetes Patients to Degludec from Other Basal Insulins Provides Different Clinical Benefits According to Their Baseline Glycemic Control. Adv Ther 2019; 36:1201-1210. [PMID: 30879256 PMCID: PMC6824376 DOI: 10.1007/s12325-019-00916-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The stable, ultra-long duration of action of insulin degludec (degludec) minimizes fluctuations in glucose-lowering activity over the daily (24-h) dosing period, and comparative studies with other basal insulins suggest that these properties translate into a lower risk of hypoglycemia at equivalent levels of glycemic control. Results from the real-world European multicenter, retrospective chart review study of 2550 patients with type 1 and type 2 diabetes (T1D and T2D) in routine clinical care EU-TREAT (NCT02662114) showed that patients benefited from improved glycemic control and significantly reduced rates of hypoglycemia following a switch to degludec. METHODS In this post hoc analysis, EU-TREAT patients were stratified into good (≤ 7.5% HbA1c), intermediate (> 7.5 to ≤ 8.5% HbA1c), and poor (> 8.5% HbA1c) glycemic control at baseline to investigate the possibility of differential benefits, either improved control or reduced risk of hypoglycemia, whichever the need. Changes in HbA1c, overall hypoglycemia, and total insulin dose from baseline to 6 and 12 months follow-up were assessed for each group. RESULTS For both T1D and T2D patients, those in good initial control experienced significant reductions in rates of hypoglycemia and total insulin dose following the switch, without compromising control. Those in poor initial control achieved significant improvements in HbA1c with no change in rates of hypoglycemia or total insulin dose. CONCLUSION This analysis expands the findings of EU-TREAT by showing differential changes in the clinical endpoints depending on particular need. It introduces the possibility that the differential benefits of degludec could address two of the renowned clinical challenges faced when treating diabetes: improving glycemic control for optimal management of T1D and titrating insulin dose in T2D, both without fear of increased hypoglycemia. TRIAL REGISTRATION ClinicalTrials.gov, NCT02662114. FUNDING Novo Nordisk A/S.
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Affiliation(s)
| | | | | | | | | | - Bernd Schultes
- eSwiss Medical and Surgical Center, St Gallen, Switzerland
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10
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Takeishi S, Tsuboi H, Takekoshi S. Comparison of morning basal + 1 bolus insulin therapy (insulin glulisine + insulin glargine 300 U/mL vs insulin lispro + insulin glargine biosimilar) using continuous glucose monitoring: A randomized crossover study. J Diabetes Investig 2017; 9:91-99. [PMID: 28371461 PMCID: PMC5754533 DOI: 10.1111/jdi.12661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/13/2017] [Accepted: 03/21/2017] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION We compared the effects of morning administration of insulin glulisine + insulin glargine 300 U/mL (G + G300) with that of insulin lispro + insulin glargine biosimilar (L + GB). MATERIALS AND METHODS A total of 30 patients with type 2 diabetes who wore a continuous glucose monitoring device on admission after glucose levels were stabilized by morning long-acting and ultra-rapid-acting insulins were randomly allocated to groups who received G + G300 on days 1 and 2, and the same dose L + GB on days 3 and 4, or vice versa. Data collected on days 2 and 4 (mean amplitude of glycemic excursion, mean of daily differences: all days) were analyzed. Insulin was injected at 08.00 h. A day was defined as the period from 08.00 h one day, to 08.00 h the next day. Test meals were given. RESULTS Increased post-breakfast glucose level, post-breakfast glucose gradient, mean glucose level, standard deviation and M-value (24 h, 00.00-06.00 h), mean amplitude of glycemic excursion, and mean of daily differences were significantly lower in patients taking G + G300 than those taking L + GB (P ≤ 0.0001-0.04). The area over the glucose curve (<70 mg/dL) was not significantly different between groups. Pre-lunch - pre-breakfast glucose levels were significantly lower in patients taking L + GB than those taking G + G300 (P < 0.0001). The difference in the highest post-breakfast glucose level between groups (Δ = G + G300 - L + GB) was significantly correlated to 24-h mean glucose level (r = 0.40, P = 0.03). CONCLUSIONS Compared with L + GB, G + G300 decreases post-breakfast glucose level reducing rate of rise of that, nocturnal and 24-h glucose variability and level without causing hypoglycemia, and daily variance.
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Affiliation(s)
- Soichi Takeishi
- Department of Diabetes, General Inuyamachuo Hospital, Inuyama-city, Aichi, Japan
| | - Hiroki Tsuboi
- Department of Diabetes, General Inuyamachuo Hospital, Inuyama-city, Aichi, Japan
| | - Shodo Takekoshi
- Department of Diabetes, General Inuyamachuo Hospital, Inuyama-city, Aichi, Japan
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11
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Pechenov S, Bhattacharjee H, Yin D, Mittal S, Subramony JA. Improving drug-like properties of insulin and GLP-1 via molecule design and formulation and improving diabetes management with device & drug delivery. Adv Drug Deliv Rev 2017; 112:106-122. [PMID: 28153578 DOI: 10.1016/j.addr.2017.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 01/20/2017] [Accepted: 01/25/2017] [Indexed: 12/25/2022]
Abstract
There is an increased incidence of diabetes worldwide. The discovery of insulin revolutionized the management of diabetes, the revelation of glucagon-like peptide-1 (GLP-1) and introduction of GLP-1 receptor agonists to clinical practice was another breakthrough. Continued translational research resulted in better understanding of diabetes, which, in combination with cutting-edge biology, chemistry, and pharmaceutical tools, have allowed for the development of safer, more effective and convenient insulins and GLP-1. Advances in self-administration of insulin and GLP-1 receptor agonist therapies with use of drug-device combination products have further improved the outcomes of diabetes management and quality of life for diabetic patients. The synergies of insulin and GLP-1 receptor agonist actions have led to development of devices that can deliver both molecules simultaneously. New chimeric GLP-1-incretins and insulin-GLP-1-incretin molecules are also being developed. The objective of this review is to summarize molecular designs to improve the drug-like properties of insulin and GLP-1 and to highlight the continued advancement of drug-device combination products to improve diabetes management.
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Affiliation(s)
| | - Himanshu Bhattacharjee
- Merck Research Laboratories, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Daniel Yin
- Merck Research Laboratories, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Sachin Mittal
- Merck Research Laboratories, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
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12
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Asias BD, Stock EM, Small NL, Getchell KE, Patel JR, Krause JD, Cavness S, Dzenowski CL, Ta M. Clinical and financial outcomes of switching insulin glargine to insulin detemir in a veteran population with type 2 diabetes. J Diabetes Metab Disord 2015; 14:53. [PMID: 26120575 PMCID: PMC4482160 DOI: 10.1186/s40200-015-0180-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 06/08/2015] [Indexed: 01/20/2023]
Abstract
Background Although glargine and detemir are both FDA-approved in the U.S. as long-acting insulin analogues, inherent differences in the insulins may lead to varying outcomes. This study examined changes in clinical measures and associated costs for veterans with type 2 diabetes on insulin therapy converted from insulin glargine to insulin detemir. Methods A retrospective before-and-after comparison study was performed at a single-site medical center located in the southwestern U.S., comprising 133 Veterans diagnosed with type 2 diabetes receiving insulin therapy with glargine and converted to insulin detemir using a 1:1 unit dosage ratio. Patients’ A1c, weight, body mass index, total daily dose, and estimated monthly insulin costs during and after conversion were compared employing Wilcoxon signed-rank tests. These measures were similarly assessed in patients at A1c goal (<7 %) prior to conversion. Results When switched from insulin glargine to insulin detemir, an increase in A1c (median of 7.7 % to 8.3 %, p < 0.01) and total daily dose (TDD: 40 to 46 units/day, p < 0.01) resulted. Monthly insulin costs decreased 19 % ($47 to $38, p < 0.01), or roughly a one-year savings of $110 per patient. An increase in A1c was similarly observed for patients at-goal prior to conversion but remained at-goal post-conversion (6.5 % to 6.7 %, p = 0.02). Conclusion The increase in A1c and TDD following conversion from insulin glargine to insulin detemir suggests that glargine requires a smaller amount of units to reach the same glycemic-lowering ability compared to detemir. Despite the observed insulin cost savings associated with detemir, future studies should also determine overall costs (including indirect) and benefits associated with switching from glargine to detemir among Veteran with Type 2 diabetes.
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Affiliation(s)
- Bernadette D Asias
- Department of Pharmacy Services, Memorial Hermann Health Care System - Texas Medical Center, Houston, TX 77030 USA ; Central Texas Veterans Health Care System, Department of Veterans Affairs, Temple, TX 76504 USA
| | - Eileen M Stock
- Center for Applied Health Research, Central Texas Veterans Health Care System in collaboration with Baylor Scott & White Health, Temple, TX 76502 USA ; Texas A&M Health Science Center, College of Medicine, Bryan, TX 77807 USA
| | - Nancy L Small
- Central Texas Veterans Health Care System, Department of Veterans Affairs, Temple, TX 76504 USA
| | - Katerine E Getchell
- Central Texas Veterans Health Care System, Department of Veterans Affairs, Temple, TX 76504 USA
| | - Jagruti R Patel
- Central Texas Veterans Health Care System, Department of Veterans Affairs, Temple, TX 76504 USA
| | - Jennifer D Krause
- Central Texas Veterans Health Care System, Department of Veterans Affairs, Temple, TX 76504 USA
| | - Staci Cavness
- Central Texas Veterans Health Care System, Department of Veterans Affairs, Temple, TX 76504 USA
| | - Cassidy L Dzenowski
- Central Texas Veterans Health Care System, Department of Veterans Affairs, Temple, TX 76504 USA
| | - Mia Ta
- Central Texas Veterans Health Care System, Department of Veterans Affairs, Temple, TX 76504 USA
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Kim JH, Ahn JH, Kim SK, Lee DH, Kim HS, Shon HS, Jeon HJ, Kim TH, Cho YW, Kim JT, Han SM, Chung CH, Ryu OH, Lee JM, Lee SH, Kwon MJ, Kim TK, Namgoong IS, Kim ES, Jung IK, Moon SD, Han JH, Kim CH, Cho EH, Kim KY, Park HB, Lee KS, Lee SW, Lee SC, Kang CM, Jeon BS, Song MS, Yun SB, Chung HK, Seong JH, Jeong JY, Cha BY. Combined use of basal insulin analog and acarbose reduces postprandial glucose in patients with uncontrolled type 2 diabetes. J Diabetes Investig 2015; 6:219-26. [PMID: 25802730 PMCID: PMC4364857 DOI: 10.1111/jdi.12261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 06/19/2014] [Accepted: 06/23/2014] [Indexed: 11/27/2022] Open
Abstract
Aims/Introduction Early initiation of basal insulin therapy is recommended for normalizing fasting blood glucose in type 2 diabetes mellitus. However, basal insulin treatment might not adequately control postprandial glucose levels. The present study evaluated whether the combination of the α-glucosidase inhibitor, acarbose, and basal insulin improved blood glucose control under daily-life treatment conditions in a large sample of Korean patients. Materials and Methods The present study was a multicenter, prospective, observational study under daily-life treatment conditions. A total of 539 patients with type 2 diabetes who were treated with basal insulin and additional acarbose were enrolled and followed up for 20 weeks. Changes in hemoglobin A1c, fasting and postprandial blood glucose were evaluated at baseline and at the end of the observation period. The physician and patient satisfaction of the combination treatment and safety were assessed. Results Hemoglobin A1c decreased by 0.55 ± 1.05% from baseline (P < 0.0001). Fasting and postprandial blood glucose levels were reduced by 0.89 ± 3.79 and 2.59 ± 4.77 mmol/L (both P < 0.0001). The most frequently reported adverse drug reactions were flatulence (0.37%) and abnormal gastrointestinal sounds (0.37%), and all were mild in intensity and transient. In the satisfaction evaluation, 79.0% of physicians and 77.3% of patients were ‘very satisfied’ or ‘satisfied’ with the combined basal insulin and acarbose therapy. Conclusions Combination therapy of basal insulin and acarbose in patients with type 2 diabetes improved glucose control, and had no drug-specific safety concerns, suggesting that the treatment might benefit individuals who cannot control blood glucose with basal insulin alone.
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Affiliation(s)
- Ji-Hyun Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine Seoul, Korea
| | - Ji-Hyun Ahn
- Department of Internal Medicine, Hansuh Hospital Seoul, Korea
| | - Soo-Kyung Kim
- Department of Internal Medicine, CHA University School of Medicine Seongnam, Korea
| | - Dae-Ho Lee
- Department of Internal Medicine, Jeju National University College of Medicine Jeju, Korea
| | - Hye-Soon Kim
- Department of Internal Medicine, Keimyung University College of Medicine Daegu, Korea
| | - Ho-Sang Shon
- Department of Internal Medicine, Daegu Catholic University College of Medicine Daegu, Korea
| | - Hyun-Jeong Jeon
- Department of Internal Medicine, Chungbuk National University College of Medicine Cheongju, Korea
| | - Tae-Hwa Kim
- Department of Internal Medicine, Hanyang University College of Medicine Seoul, Korea
| | - Yong-Wook Cho
- Department of Internal Medicine, CHA University School of Medicine Seongnam, Korea
| | - Jae-Taek Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine Seoul, Korea
| | - Sung-Min Han
- Department of Internal Medicine, Mizmedi Hospital Seoul, Korea
| | - Choon-Hee Chung
- Department of Internal Medicine, Yonsei University Wonju College of Medicine Wonju, Korea
| | - Ohk-Hyun Ryu
- Department of Internal Medicine, Hallym University College of Medicine Chuncheon, Korea
| | - Jae-Min Lee
- Department of Internal Medicine, Eulji University College of Medicine Daejeon, Korea
| | - Soon-Hee Lee
- Department of Internal Medicine, Inje University College of Medicine Busan, Korea
| | - Min-Jeong Kwon
- Department of Internal Medicine, Inje University College of Medicine Busan, Korea
| | - Tae-Kyun Kim
- Department of Internal Medicine, Inje University College of Medicine Busan, Korea
| | - Il-Seong Namgoong
- Department of Internal Medicine, University of Ulsan College of Medicine Ulsan, Korea
| | - Eun-Sook Kim
- Department of Internal Medicine, University of Ulsan College of Medicine Ulsan, Korea
| | - In-Kyung Jung
- Department of Internal Medicine, KyungHee University College of Medicine Seoul, Korea
| | - Sung-Dae Moon
- Department of Internal Medicine, The Catholic University of Korea College of Medicine Seoul, Korea
| | - Je-Ho Han
- Department of Internal Medicine, The Catholic University of Korea College of Medicine Seoul, Korea
| | - Chong-Hwa Kim
- Department of Internal Medicine, Sejong General Hospital Bucheon, Korea
| | - Eun-Hee Cho
- Department of Internal Medicine, Kangwon National University College of Medicine Chuncheon, Korea
| | | | | | - Ki-Sang Lee
- Saeseoul Internal Medicine Clinic Daejeon, Korea
| | - Sung-Woo Lee
- Lee Seongwoo Internal Medicine Clinic Wonju, Korea
| | | | | | | | | | | | | | - Jong-Ho Seong
- Kwangyang Sacred Heart Internal Medicine Clinic Gwangyang, Korea
| | - Jin-Yi Jeong
- Yonsei Jeong Internal Medicine Clinic Seoul, Korea
| | - Bong-Yun Cha
- Department of Internal Medicine, The Catholic University of Korea College of Medicine Seoul, Korea
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