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Outcome of Degludec and Glargine on Fasting Plasma Glucose in T1D Patients

Insulin has different impact on fasting plasma glucose and day-to-day changes…

The duration of action for degludec is approximately 42 hours and is much longer than the duration of action of glargine. Due to degludec pharmacokinetics, it leads to a slower absorption rate from the injection site to the blood stream. The delay in absorption is due to the formation of soluble multihexameric chains, which prolongs retention in the circulation as a result of its binding to albumin in the blood. A previous study suggested that basal-bolus treatment with degludec is related to a parallel level of glycemic control, with a reduced daily dose and less incidence of nocturnal hypoglycemia, to glargine.

The purpose of the study was to evaluate the outcome of degludec and glargine on the day-to-day changes of fasting plasma glucose in patients with diabetes treated with basal-bolus insulin injections. The trial was conducted as a multicenter, randomized, crossover study that consisted of 36 patients. The study monitored the effects of the basal-bolus insulin therapy for four weeks with either glargine or degludec in patients with type 1 diabetes. The primary endpoint was standard deviation of fasting blood glucose during the final week of each treatment interval. The secondary endpoints were serum glycoalbumin levels, total daily dose of insulin, intraday glycemic changes, and incidence of severe low blood glucose.

The results showed that of the 36 participants who were recruited, 32 completed the trial. The average (7.74 ± 1.76 vs 8.56 ± 2.06 mmol/l; p = 0.04) and SD (2.60 ± 0.97 vs 3.19 ± 1.36 mmol/l; p = 0.03) of fasting plasma glucose were decreased during degludec therapy than during glargine therapy. The total daily dose of degludec was less than that of glargine (11.0 ± 5.2 vs 11.8 ± 5.6 U/day; p < 0.01), but other secondary endpoints did not differ between the treatments.

To conclude, degludec reduced fasting plasma glucose levels and smaller day-to-day variability of fasting blood glucose at a reduced daily dose compared with glargine.

Practical Pearls:

  • Degludec reduces fasting blood glucose lower than glargine in patients with type 1 diabetes.
  • Degludec insulin serves as a great choice for basal insulin in the treatment of type 1 diabetes.
  • In comparison to glargine, patients taking degludec would have to administer less insulin per day to lower fasting plasma concentration.

Nakamura T, Sakaguchi K, So A, et al. “Effects of insulin degludec and insulin glargine on day-to-day fasting plasma glucose variability in individuals with type 1 diabetes: a multicentre, randomised, crossover study.” Diabetologia. 2015;58(9):2013-9.