Meta-Analysis Finds Insulin Degludec Outperforms Insulin Glargine on Preventing Hypoglycemia

A review of 15 studies has found that insulin degludec, sold by Novo Nordisk as Tresiba, does a better job of overall job of preventing hypoglycemia in people with type 2 diabetes (T2D) and is also associated with lower rates of nocturnal hypoglycemia in people with T2D and type 1 diabetes (T1D).

The meta-analysis appeared in the International Journal of Endocrinology around the same time FDA approved an updated label for insulin degludec, reflecting results of recent clinical trials that showed no increased risk of major cardiovascular events as well as a 40% reduction in severe hypoglycemia compared with insulin glargine.

The 15 trials in the analysis covered 16,328 patients and included 5 studies of that involved patients with T1D and 10 with patients with T2D. All studies used an intention-to-treat analysis. Completion rates in the studies ranged from 76.7% to 100%.

Major findings from the review are:

• Overall, reduction in fasting plasma glucose was significantly better among those taking insulin degludec, even though reductions in glycated hemoglobin (A1C) were comparable.
• The risk of hypoglycemia was statistically significantly decreased in the insulin degludec group compared with the insulin glargine group. In 13 studies where this result was reported, the events per patient-year were lower in the insulin degludec group (response rate [RR], 0.88; 95% CI, 0.81 to 0.96; P = .003).
• The overall risk of hypoglycemia was even lower for patient with T2D (RR, 0.82; 95% CI, 0.73 to 0.92; P = .001).
• Both T1D and T2D patients experienced lower rates of nocturnal hypoglycemia with insulin degludec (RR, 0.74; 95% CI, 0.69 to 0.79; P <.001).
• There were no statistically significant differences between the 2 groups for serious adverse events.

“Glycemic control is vital for patients with (diabetes),” the authors write. Microvascular and macrovascular complications of diabetes declined dramatically over the past 2 decades, “but have reappeared with a higher rate of hospital admissions for hypoglycemic events. Therefore, the development of an effective antidiabetic treatment with a lower rate of hypoglycemic events than that with the current treatment is important.”

Reducing the risk of nocturnal hypoglycemia is important, especially to patients with T1D, because this is a major source of anxiety and causes people with diabetes to suffer disrupted sleep.

The study was funded by the National Clinical Key Specialty Construction Project of China and the Clinical Research Project of the Department of Science and Technology of Guizhou Province.

Reference

Liu W, Yang X, Huang J. Efficacy and safety of insulin degludec versus insulin glargine: a systematic review and meta-analysis of 15 clinical trials [published March 12, 2018]. Int J Endocrinol. doi: https://doi.org/10.1155/2018/8726046.