Center for Diabetes and Endocrinology, The Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan.
Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka, 553-0003, Japan.
Clin Drug Investig. 2017 Sep;37(9):845-852. doi: 10.1007/s40261-017-0541-0.
Ultra-long-acting insulin degludec (DEG) has a longer duration of action and less daily variability relative to other basal insulin (BI), and thus may benefit patients with type 1 diabetes mellitus (T1DM). We examined the impact of switching BI to DEG on glycemic control and insulin dose in T1DM.
T1DM patients (n = 22; six male; mean age: 64.5 ± 12.6 years) receiving basal-bolus insulin therapy were included. Initially, the BI dose was replaced with DEG in a 1:1 ratio; 80-100% of the total dose was replaced with DEG for multiple basal insulin injections. DEG was titrated according to study protocol. Changes in HbA1c, daily insulin dose, glycemic self-monitored blood glucose variations, and hypoglycemia frequency were evaluated for 24 weeks.
Once-daily DEG significantly decreased HbA1c levels when switched from once-daily BI (7.9 ± 0.8 vs. 7.5 ± 0.9%, p = 0.020) and maintained HbA1c when switched from twice-daily BI (8.5 ± 1.6 vs. 8.4 ± 1.2%, p = 0.457). The BI dose decreased by -7.8 ± 13.9% (p = 0.017) and -16.6 ± 16.9% (p = 0.050) when switched from once-daily BI and twice-daily BI, respectively. The total bolus insulin dose significantly decreased when switched from once-daily BI (21.7 ± 8.3 to 19.3 ± 8.8 U/day, p = 0.016) especially in the injection before breakfast and evening meal. Body weight and hypoglycemia frequency was not significantly different.
DEG improved glycemic control when switched from once-daily BI and maintained glycemic control when switched from twice-daily BI without increasing hypoglycemia.
超长效胰岛素 Degludec（DEG）的作用持续时间长，每日变异性小于其他基础胰岛素（BI），因此可能对 1 型糖尿病（T1DM）患者有益。我们研究了将 BI 转换为 DEG 对 T1DM 患者血糖控制和胰岛素剂量的影响。
纳入正在接受基础-餐时胰岛素治疗的 22 例 T1DM 患者（6 例男性；平均年龄：64.5±12.6 岁）。首先，将 BI 剂量以 1:1 的比例替换为 DEG；对于多次基础胰岛素注射，将 80-100%的总剂量替换为 DEG。根据研究方案调整 DEG 的剂量。在 24 周时评估 HbA1c、每日胰岛素剂量、血糖自我监测的血糖变化和低血糖发作频率的变化。
与从每日一次 BI 转换相比，每日一次 DEG 显著降低 HbA1c 水平（7.9±0.8 比 7.5±0.9%，p=0.020），并在从每日两次 BI 转换时维持 HbA1c（8.5±1.6 比 8.4±1.2%，p=0.457）。当从每日一次 BI 和每日两次 BI 转换时，BI 剂量分别减少了-7.8±13.9%（p=0.017）和-16.6±16.9%（p=0.050）。与从每日一次 BI 转换时相比，总餐时胰岛素剂量显著减少（21.7±8.3 比 19.3±8.8 U/天，p=0.016），尤其是在早餐前和晚餐前注射时。体重和低血糖发作频率无显著差异。
DEG 改善了从每日一次 BI 转换后的血糖控制，并且在从每日两次 BI 转换后维持血糖控制，而不会增加低血糖。
