Galasso S, Facchinetti A, Bonora B M, Mariano V, Boscari F, Cipponeri E, Maran A, Avogaro A, Fadini G P, Bruttomesso D
Department of Medicine, University of Padova, 35128 Padova, Italy.
Department of Informatic Engineering, University of Padova, 35128 Padova, Italy.
Nutr Metab Cardiovasc Dis. 2016 Dec;26(12):1112-1119. doi: 10.1016/j.numecd.2016.08.002. Epub 2016 Aug 6.
Degludec is an ultralong-acting insulin analogue with a flat and reproducible pharmacodynamic profile. As some patients with type 1 diabetes (T1D) fail to achieve 24-h coverage with glargine or detemir despite twice-daily injections, we studied the effect of switching T1D patients from twice-daily glargine or detemir to degludec.
In this prospective observational study, T1D patients on twice-daily glargine or detemir were enrolled. At baseline and 12 weeks after switching to degludec, we recorded HbA1c, insulin dose, 30-day blood glucose self monitoring (SMBG) or 14-day continuous glucose monitoring (CGM), treatment satisfaction (DTSQ), fear of hypoglycemia (FHS). We included 29 patients (mean age 34 ± 11 years; diabetes duration 18 ± 10 years). After switching to degludec, HbA1c decreased from 7.9 ± 0.6% (63 ± 6 mmol/mol) to 7.7 ± 0.6% (61 ± 6 mmol/mol; p = 0.028). SMBG showed significant reductions in the percent and number of blood glucose values <70 mg/dl and in the low blood glucose index (LBGI) during nighttime. CGM showed a significant reduction of time spent in hypoglycemia, an increase in daytime spent in target 70-180 mg/dl, and a reduction in glucose variability. Total insulin dose declined by 17% (p < 0.001), with 24% reduction in basal and 10% reduction in prandial insulin. DTSQ and FHS significantly improved.
Switching from twice-daily glargine or detemir to once daily degludec improved HbA1c, glucose profile, hypoglycemia risk and treatment satisfaction, while insulin doses decreased. ClinicalTrials.govNCT02360254.
德谷胰岛素是一种超长效胰岛素类似物，具有平稳且可重复的药效学特征。由于一些1型糖尿病（T1D）患者尽管每日注射两次甘精胰岛素或地特胰岛素，仍无法实现24小时血糖覆盖，我们研究了将T1D患者从每日两次甘精胰岛素或地特胰岛素转换为德谷胰岛素的效果。
在这项前瞻性观察研究中，纳入了每日两次注射甘精胰岛素或地特胰岛素的T1D患者。在基线期以及转换为德谷胰岛素12周后，我们记录了糖化血红蛋白（HbA1c）、胰岛素剂量、30天自我血糖监测（SMBG）或14天连续血糖监测（CGM）、治疗满意度（糖尿病治疗满意度问卷，DTSQ）、低血糖恐惧（FHS）。我们纳入了29例患者（平均年龄34±11岁；糖尿病病程18±10年）。转换为德谷胰岛素后，HbA1c从7.9±0.6%（63±6 mmol/mol）降至7.7±0.6%（61±6 mmol/mol；p = 0.028）。SMBG显示血糖值<70 mg/dl的百分比和数量以及夜间低血糖指数（LBGI）显著降低。CGM显示低血糖时间显著减少，70 - 180 mg/dl目标范围内的日间时间增加，血糖变异性降低。总胰岛素剂量下降了17%（p < 0.001），基础胰岛素减少24%，餐时胰岛素减少10%。DTSQ和FHS显著改善。
从每日两次甘精胰岛素或地特胰岛素转换为每日一次德谷胰岛素可改善HbA1c、血糖谱、低血糖风险和治疗满意度，同时胰岛素剂量降低。ClinicalTrials.govNCT02360254。
