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New Insulin Combo Degludec Reduces Hypo’s in Poorly Controlled Diabetes

Insulin degludec/insulin aspart does better than biphasic insulin aspart 30 in type 2 diabetes inadequately controlled with other regimens…. 

The combination product is the first to contain "a basal insulin with an ultralong duration of action, and a rapid-acting insulin in a single injection.

The researchers conducted an open label study of 447 people with diabetes. In all patients, the disease was inadequately controlled with once- or twice-daily pre-mixed or self-mixed insulin with or without oral antidiabetic drugs.

They were randomized to twice daily injection of the combination or biphasic insulin aspart 30. This was administered with breakfast and the main evening meal and the dose titrated to a self-measured premeal plasma glucose target of 72mg/dL.- 90 mg/dL.(4.0-5.0 mmol/L.)

At 26 weeks mean HbA1c was 7.1% in both groups. The combination was significantly better at lowering fasting plasma glucose (FPG). It also allowed a significant 11% lower final mean daily insulin dose, giving an estimated rate ratio of 0.89.

The researchers point out that the greater reduction in FPG was accompanied by reductions in hypoglycemia. This amounted to 32% for confirmed episodes, 73% for nocturnal confirmed episodes and 50% for severe hypoglycemia.

Diabetes expert Dr. Irl B. Hirsch added that, "This article is consistent with other studies in the late-phase degludec program: no matter the comparator, degludec either alone or in combination with a prandial insulin results in less confirmed hypoglycemia, particularly nocturnal hypoglycemia."

Practice Pearls:

  • The twice daily injection of the combination or biphasic insulin aspart 30, was better at lowering FPG.
  • The injections also provided a significant reduction in hypoglycemic events including nocturnal episodes

Diabetes Care June 2014