Switching Patients with Type 1 Diabetes to Insulin Degludec from Other Basal Insulins: Real-World Data of Effectiveness and Safety

Abstract

Introduction: Real-world evidence on the effectiveness and safety of insulin degludec (IDeg) in patients with diabetes is a priority. We have therefore evaluated the effectiveness and safety of IDeg, including impact on metabolic control, glycemic variability, weight gain and hypoglycemia, in patients with type 1 diabetes under routine clinical practice conditions. Methods: This was an observational longitudinal multicenter study. A retrospective chart review of all patients with type 1 diabetes who were switched from basal insulin to IDeg was performed, and temporal trends in clinical outcomes were assessed. Results: Data obtained from 195 patients, with a median age of 42.8 [interquartile range (IQR) 24.6–56.4] years and a median diabetes duration of 16 (IQR 10.0–28) years, were analyzed. Median follow-up was 9.5 (IQR 7.7–11.3) months. Improvements were found in glycated hemoglobin (− 0.34%; p < 0.0001), fasting blood glucose (− 24.82 mg/dL; p < 0.0001), post-prandial glucose (− 17.23 mg/dL; p = 0.0009), glycemic variability as indicated by standard deviation of blood glucose (− 5.67 mg/dL; p < 0.0001) and high blood glucose index (− 3.77; p < 0.0001). Body weight and body mass index remained substantially stable during the follow-up (− 0.18 kg; p = 0.56 and − 0.12; p = 0.42, respectively). Risk of nocturnal hypoglycemia decreased by 52% [incidence rate ratio 0.48; 95% confidence interval (CI) 0.29–0.77] and risk of total hypoglycemic episodes by 41% (incidence ratio 0.59; 95% CI 0.45–0.83). Basal and short-acting insulin doses decreased by − 1.4 and − 3.1 IU, respectively. Conclusion: Switching patients with type 1 diabetes to IDeg from other basal insulins was associated with relevant improvements in metabolic control and glycemic variability without weight gain; the risk of hypoglycemic episodes also significantly declined. Funding: Novo Nordisk S.p.A. unconditional grant.