Similar glycemic control with glargine U300, U100 for inpatients with type 2 diabetes
medwireNews: Hospitalized people with poorly controlled type 2 diabetes who are treated with insulin glargine U300 have comparable glycemic control to those given the U100 formulation, and may have a lower risk for hypoglycemia, researchers report.
The open-label phase 4 Glargine U300 Hospital Trial included 176 individuals receiving treatment with oral antidiabetic agents or insulin before admission who had an average glycated hemoglobin level of approximately 9.5% (80 mmol/mol) and were not critically ill.
Participants were randomly assigned to receive either glargine U300 or glargine U100 once daily as their basal insulin, together with three doses of prandial insulin before meals, during hospitalization. Insulin doses were adjusted daily to maintain target blood glucose levels between 100 and 180 mg/dL (5.5–10.0 mmol/L).
Guillermo Umpierrez (Emory University School of Medicine, Atlanta, Georgia, USA) and co-investigators report in Diabetes Care that average daily blood glucose concentrations improved to a comparable degree among participants receiving the two basal insulin formulations over a median inpatient stay of 6 days.
Specifically, blood glucose levels improved from a mean of 218.7 mg/dL (12.1 mmol/L) at the time of randomization to a daily average of 186.0 mg/dL (10.3 mmol/L) during hospitalization among the 92 patients in the U300 group, and from 216.4 to 184.0 mg/dL (12.0 to 10.2 mmol/L) among the 84 given the U100 formulation.
Umpierrez and team say that the between-group difference in mean daily blood glucose of 2.49 mg/dL (0.13 mmol/L) fell below the predefined threshold for noninferiority of 18 mg/dL (0.99 mmol/L), supporting “the hypothesis that the use of glargine U300 is as effective as glargine U100 for the management of hyperglycemia in noncritically ill patients with [type 2 diabetes] admitted to medical or surgical services.”
The researchers also found that clinically significant hypoglycemia (blood glucose <54 mg/dL [3 mmol/L]) occurred significantly less frequently among individuals treated with U300 versus U100, with rates of 0% versus 6%, but they note that such episodes were “infrequent” overall.
These findings are in accordance with previous observations, and “[t]he fact that glargine U300 has consistently shown a reduction in the risk of hypoglycemia provides a potential advantage, particularly for patients at higher risk for hypoglycemia (i.e., elderly patients, chronic kidney disease),” write the study authors.
They say that “there was no signal of increased risk” for in-hospital complications – including cardiovascular complications, renal failure, respiratory failure, infections, and mortality – with glargine U300 versus U100, with rates of 6.5% and 11.0%, respectively, but caution that the study was not powered to assess this endpoint.
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