medwireNews: Insulin degludec offers similar glycemic outcomes to insulin glargine U100, along with more straightforward dosing, for people with insulin-treated diabetes crossing time zones, a small study suggests.
“[T]raveling with insulin has been a neglected topic among the research community but is an important real-world consideration for people with diabetes and their families,” write Wendy Bevier (Sansum Diabetes Research Institute, Santa Barbara, California, USA) and co-researchers in Diabetes Care.
They say that there is little evidence-based information to support people with diabetes to adjust insulin while travelling; that clinicians, including endocrinologists, are often also lacking this knowledge; and that some existing information is “potentially harmful.”
For this study, the team recruited 21 people, aged an average of 35 years, who had insulin-treated diabetes. They randomly assigned them to use insulin degludec or glargine U100 and arranged for them to fly from California, to Hawaii, to New York, and back to California, with breaks of 48–72 hours at each destination to adjust to the local time zone. After a 2-week break, the participants repeated the trip, this time using the other insulin.
The two insulins produced similar results for almost every variable measured, and the only exceptions to this both favored degludec over glargine. These were, firstly, significantly less jetlag after 24 and 48 hours at the destination during eastward travel, and, secondly, significantly less fatigue after 48 hours at the destination during westward travel.
Bevier and colleagues speculate that these differences “may have been due to the time intensiveness and concentration needed for calculations and timing of insulin injections.”
They note that a daily injection of degludec, with “the opportunity to vary time of injection between 8 and 40 [hours],” should be simpler to manage while crossing time zones than existing insulins, which require “complex adjustments to dose and timing based on the direction of travel.”
But the team concedes: “The difficulty of using the insulins was not measured and would have contributed to a better understanding of jet lag and fatigue.”
Although glycemic control did not differ between the insulins, the researchers found it to be generally poor during travel. For example, the time in range of 70–180 mg/dL (3.9–10.0 mmol/L) during eastward travel was 50.5–58.9% in flight and 55.0–62.3% during the first 24 hours after landing, rather than the recommended 70.0%.
Bevier and team observe that “there are no data to determine whether [targets such as] these remain realistic in certain situations such as long-distance travel,” and conclude that their study “provides further evidence that long-distance flying while taking multiple injections of insulin can be challenging.”
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