Fixed degludec–aspart co-formulation shows promise in pediatric diabetes
medwireNews: The fixed soluble co-formulation of insulin degludec/insulin aspart (IDegAsp) offers similar glycemic control to insulin detemir (IDet) when each are combined with mealtime insulin aspart (IAsp) in children with type 1 diabetes, research shows.
Furthermore, the noninferiority of IDegAsp versus IDet was achieved at a lower insulin dose with fewer daily injections, report Tadej Battelino (UMC – University Children's Hospital, Ljubljana, Slovenia) and colleagues in Pediatric Diabetes.
They found that glycated hemoglobin (HbA1c) decreased by an average 0.27% (2.98 mmol/mol) in the 182 children and adolescents (aged 1–17 years) who were randomly assigned to receive 16 weeks of treatment with IDegAsp once daily plus IAsp for their remaining meals.
This compared with an average decrease of 0.23% (2.53 mmol/mol) over 16 weeks among the 180 participants randomly assigned to receive IDet once or twice daily plus mealtime IAsp, a difference that was not statistically significant.
Patients in the IDegAsp plus IAsp group gained significantly more weight during the course of the trial than did those in the IDet plus IAsp, but experienced a nonsignificant reduction in the rate of hyperglycemia with ketosis (2.2 vs 4.5%).
Therefore “clinicians may consider the weight-sparing effect of IDet compared with the ketosis benefit of IDegAsp when choosing appropriate treatments for this patient population,” Battelino et al remark.
There were no significant differences between the two groups in fasting or self-measured plasma glucose, or in the rate of confirmed hypoglycemia, but there was a nonsignificant increase in the rate of severe hypoglycemia with IDegAsp plus IAsp versus IDet plus IAsp, at 6.1% versus 1.7%.
A post-hoc analysis showed that basal insulin dose was reduced by a significant 26% with IDegAsp plus IAsp versus IDet plus IAsp, while total insulin dose was reduced by a significant 15%. The mean number of daily injections was 3.6 and 4.9, respectively.
The authors conclude: “IDegAsp, as the first fixed soluble co-formulation insulin, could offer the potential benefit of fewer injections compared with a traditional basal–bolus regimen, and may therefore represent an addition to the treatment options for pediatric individuals with [type 1 diabetes] for whom a treatment option with fewer injections is important or where adherence may be a challenge.”
By Laura Cowen
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