Basal insulin works in poorly controlled type 2 diabetes
medwireNews: Insulin glargine (Gla)-300 and insulin degludec (IDeg)-100 provide a similar level of glycemic control in patients with poorly controlled type 2 diabetes, results of the BRIGHT study show.
The rate of hypoglycemia during the entire 24-week study period and during the 12-week maintenance period was also similar between the two treatments, but was a significant 23–43% lower with Gla-300 than with IDeg-100 during the 12-week titration period, reported Alice Cheng (University of Toronto, Ontario, Canada) at the ADA’s 78th Scientific Sessions in Orlando, Florida, USA.
During this initial period, the incidence of confirmed hypoglycemia with Gla-300 versus IDeg-100 was 47.4% versus 54.3% at or below 70 mg/dL and 7.8% versus 11.7% below 54 mg/dL.
The corresponding event rates were 8.08 versus 10.47 per patient–year and 0.49 versus 0.86 per patient–year.
In what Cheng describes as “the first head-to-head trial designed to compare the efficacy and safety of Gla-300 with IDeg-100,” 929 insulin-naïve adults with type 2 diabetes (mean glycated hemoglobin [HbA1c], 8.6%) inadequately controlled with oral antihyperglycemic drugs were randomly assigned to receive one or the other of the insulin treatments.
At 24 weeks, the mean reduction in HbA1c was 1.6% in both groups and met the noninferiority criteria.
Cheng said this shows “that basal insulin when used properly and adequately titrated works” in patients with poorly controlled type 2 diabetes.
There was also no significant difference between Gla-300 with IDeg-100 in the reduction in fasting self-monitored plasma glucose (SMPG; 58.1 vs 59.2 mg/dL) or in the 8-point SMPG profiles and 24-hour variability in SMPG and fasting SMPG at both baseline and week 24.
The final daily insulin dose was higher with Gla-300 than with IDeg-100, at 0.54 versus 0.43 U/kg, from starting evening doses of 0.19 U/kg and 0.12 U/kg, respectively.
Cheng noted, however, that the higher dose with Gla-300 did not translate to greater weight gain. Indeed, patients who received Gla-300 gained 2.0 kg, on average, compared with a gain of 2.3 kg among those who received IDeg-100.
There were no unexpected adverse events reported and the rate of treatment-emergent adverse events was similar between the two groups.
By Laura Cowen
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