Effects of Switching from Degludec to Glargine U300 in Patients with Insulin-Dependent Type 1 Diabetes: A Retrospective Study

• Published in: Medicina (Kaunas, Lithuania) Lithuania), 2024-03, Vol.60 (3), p.450
• Main Authors: Sawamura, Toshitaka, Karashima, Shigehiro, Ohbatake, Azusa, Higashitani, Takuya, Ohmori, Ai, Sawada, Kei, Yamamoto, Rika, Kometani, Mitsuhiro, Katsuda, Yuko, Yoneda, Takashi
• Format: Article
• Language: English
• Subjects: Albumin; Analysis; Blood Glucose - analysis; Blood sugar; Blood sugar monitoring; Body mass index; Care and treatment; Control algorithms; degludec; Dementia; Diabetes; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 2; glargine U300; Glucose; Glycated Hemoglobin; glycemic variability; Glycosylated hemoglobin; Humans; Hyperglycemia; Hypoglycemia; Hypoglycemia - chemically induced; Hypoglycemic Agents - adverse effects; Insulin; Insulin - therapeutic use; Insulin glargine; Insulin Glargine - adverse effects; Insulin resistance; Insulin, Long-Acting; Medical research; Medicine, Experimental; Mortality; Pharmacodynamics; Proteins; Retrospective Studies; Serum Albumin; type 1 diabetes; Type 2 diabetes
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina60030450

Degludec (Deg) and glargine U300 (Gla-300) are insulin analogs with longer and smoother pharmacodynamic action than glargine U100 (Gla-100), a long-acting insulin that has been widely used for many years in type 1 and type 2 diabetes. Both improve glycemic variability (GV) and the frequency of hypoglycemia, unlike Gla-100. However, it is unclear which insulin analog affects GV and hypoglycemia better in patients with insulin-dependent type 1 diabetes. We evaluated the effects of switching from Deg to Gla-300 on the day-to-day GV and the frequency of hypoglycemia in patients with insulin-dependent type 1 diabetes treated with Deg-containing basal-bolus insulin therapy (BBT). We conducted a retrospective study on 24 patients with insulin-dependent type 1 diabetes whose treatment was switched from Deg-containing BBT to Gla-300-containing BBT. We evaluated the day-to-day GV measured as the standard deviation of fasting blood glucose levels (SD-FBG) calculated by the self-monitoring of blood glucose records, the frequency of hypoglycemia (total, severe, and nocturnal), and blood glucose levels measured as fasting plasma glucose (FPG) levels and hemoglobin A1c (HbA1c). The characteristics of the patients included in the analysis with high SD-FBG had frequent hypoglycemic events, despite the use of Deg-containing BBT. For this population, SD-FBG and the frequency of nocturnal hypoglycemia decreased after the switch from Deg to Gla-300. Despite the decrease in the frequency of nocturnal hypoglycemia, the FPG and HbA1c did not worsen by the switch. The change in the SD-FBG had a negative correlation with the SD-FBG at baseline and a positive correlation with serum albumin levels. Switching from Deg to Gla-300 improved the SD-FBG and decreased the frequency of nocturnal hypoglycemia in insulin-dependent type 1 diabetes treated with Deg-containing BBT, especially in cases with low serum albumin levels and a high GV.