Mu Y M, Guo L X, Li L, Li Y M, Xu X J, Li Q M, Xu M T, Zhu L Y, Yuan G Y, Liu Y, Xu C, Wang Z J, Shen F X, Luo Y, Liu J Y, Li Q F, Wang W H, Lai X Y, Xu H F, Pan C Y
Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Nei Ke Za Zhi. 2017 Sep 1;56(9):660-666. doi: 10.3760/cma.j.issn.0578-1426.2017.09.008.
To compare the safety and efficacy of insulin degludec (IDeg) with those of insulin glargine (IGlar) in insulin-naive subjects with type 2 diabetes (T2DM). This was a 26-week, randomized, open-label, parallel-group, treat-to-target trial in 560 Chinese subjects with T2DM (men/women: 274/263, mean age 56 years, mean diabetes duration 7 years) inadequately controlled on oral antidiabetic drugs (OADs). Subjects were randomized 2∶1 to once-daily IDeg (373 subjects) or IGlar(187 subjects), both in combination with metformin. The primary endpoint was changes from baseline in glycosylated hemoglobin(HbA1c) after 26 weeks. Mean HbA1c decreased from 8.2% in both groups to 6.9% in IDeg and 7.0% in IGlar, respectively. Estimated treatment difference (ETD) of IDeg-IGlar in change from baseline was -0.10% points (95%-0.25-0.05). The proportion of subjects achieving HbA1c<7.0% was 56.3%and 49.7% with IDeg and IGlar, respectively [estimated odds ratio of IDeg/IGlar: 1.26(95% 0.88-1.82)]. Numerically lower rateof overall confirmed hypoglycaemia and statistically significantly lower nocturnal confirmed hypoglycemia were associated with IDeg compared with IGlar, respectively [estimated rateratio of IDeg/IGlar 0.69(95% 0.46-1.03), and 0.43(95% 0.19-0.97)]. No differences in other safety parameters were found between the two groups. IDeg was non-inferior to IGlar in terms of glycaemic control, and was associated with a statistically significantly lower rate of nocturnal confirmed hypoglycaemia. IDeg is considered to be suitable for initiating insulin therapy in Chinese T2DM patients on OADs requiring intensified treatment. Clinicaltrials.gov, NCT01849289.
比较德谷胰岛素(IDeg)与甘精胰岛素(IGlar)在初治2型糖尿病(T2DM)患者中的安全性和有效性。这是一项为期26周的随机、开放标签、平行组、达标治疗试验,纳入560例口服降糖药(OADs)控制不佳的中国T2DM患者(男性/女性:274/263,平均年龄56岁,平均糖尿病病程7年)。受试者按2∶1随机分为每日一次IDeg组(373例)或IGlar组(187例),两组均联合二甲双胍。主要终点为26周后糖化血红蛋白(HbA1c)相对于基线的变化。两组的平均HbA1c分别从8.2%降至IDeg组的6.9%和IGlar组的7.0%。IDeg - IGlar相对于基线变化的估计治疗差异(ETD)为 -0.10个百分点(95%可信区间 -0.25至 -0.05)。HbA1c<7.0%的受试者比例在IDeg组和IGlar组分别为56.3%和49.7%[IDeg/IGlar的估计比值比:1.26(95%可信区间0.88至1.82)]。与IGlar相比,IDeg的总体确诊低血糖发生率在数值上较低,夜间确诊低血糖发生率在统计学上显著更低[IDeg/IGlar的估计发生率比值分别为0.69(95%可信区间0.46至1.03)和0.43(95%可信区间0.19至0.97)]。两组在其他安全参数方面未发现差异。在血糖控制方面,IDeg不劣于IGlar,且夜间确诊低血糖发生率在统计学上显著更低。IDeg被认为适用于对需要强化治疗的OADs治疗的中国T2DM患者起始胰岛素治疗。Clinicaltrials.gov,NCT01849289。