Hypoglycemia Rate, A1c Goals Compared for Basal Insulin Switches

Hypoglycemia risk after switching basal insulins were compared
Hypoglycemia risk after switching basal insulins were compared

This article is written live from the American Association of Clinical Endocrinologists (AACE) 2017 Annual Meeting in Austin, TX. MPR will be reporting news on the latest findings from leading experts in endocrinology. Check back for more news from AACE 2017.


At the AACE 2017 Annual Meeting, Fang Liz Zhou, from Sanofi U.S., Bridgewater, NJ, and colleagues presented findings from a real-world study evaluating risk of hypoglycemia among basal insulin-treated type 2 diabetes patients who switched to insulin glargine 300U/mL (GLA-300) vs. other basal insulins.

Various basal insulin analogues have been approved recently with growing data on their safety and efficacy. GLA-300, a basal insulin, was approved by the Food and Drug Administration (FDA) in 2015. In the clinical trial program, EDITION, GLA-300 therapy led to glycemic control comparable to that of insulin glargine 100U/mL (GLA-100)  as well as a lower risk of hypoglycemia in various patients with type 2 diabetes. 

"The advantages of switching to GLA-300 as compared to other basal insulins in routine real-world clinical practice settings have not been well characterized," explained Zhou. Study authors performed a retrospective cohort study called DELIVER 2 (Differentiate GLA-300 Clinical and Economic in Real-World Via EMR) data study. Electronic medical records from the Predictive Health Intelligence Environment were collected to identify patients with at least 1 type 2 diabetes diagnosis who were using basal insulin. Specifically, included patients were adults using basal insulin with available data 12 months before (baseline) and 6 months after (follow-up) switching to either GLA-300 or other basal insulins: GLA-100, insulin detemir, insulin degludec. "Patients using more than 1 basal insulin on the index date were excluded," said Zhou.

Study endpoints included change in A1c, A1c goal attainment (goal <7.0% and <8.0%), incidence and rate of hypoglycemia (glucose ≤70mg/dL) during the 6-month follow-up, healthcare utilization, and healthcare cost and cost-saving. In the analysis, patients switching to GLA-300 and to other basal insulins were propensity matched based on baseline demographics and clinical characteristics.

For 72.5% of patients in the cohort switching to GLA-300 and for 71.6% of patients in the cohort switching to other basal insulins, GLA-100 was the baseline basal insulin; the remaining patients in each group switched from insulin detemir. Among patients in the other basal insulin group, 24.1% switched to GLA-100, 65.7% switched to insulin detemir, and 10.2% of patients switched to insulin degludec.

The data showed a significant decrease in A1c of 8.40% in the GLA-300 cohort vs. 8.46% in the other basal insulin cohort during the follow-up period (both P-value <0.01). The reductions in A1c proved similar in both groups (-0.55% vs. -0.47%; P=0.14). After the follow-up period, researchers found that patients in both insulin cohorts were "equally likely" to reach A1c <7.0% (16.9% vs. 18.7%, respectively; P=0.35) and A1c <8.0% (45.0% vs. 42.0%, respectively; P=0.31). 

Regarding hypoglycemia, there were significantly less patients in the GLA-300 group that experienced hypoglycemia vs. patients in the other basal insulins (15.9% vs. 18.2%; P=0.01; adjusted odds ratio [aOR] 0.78, 95% CI: 0.65, 0.94) after controlling for baseline hypoglycemia incidence. After adjusting for baseline hypoglycemia, switching to GLA-300 resulted in significantly reduced rate of hypoglycemia at the follow-up adjusted mean (0.677 events/PPPY vs. 0.902 events/PPPY). 

Moreover, patients taking GLA-300 demonstrated a lower risk of requiring all-cause inpatient or emergency department services vs. patients in the other basal insulins (aOR inpatient 0.76, 95% CI: 0.63, 0.93; P=0.01; emergency department 0.77, 95% CI: 0.66, 0.91; P<0.01). Zhou noted, "Similarly, the outcomes of diabetes- and hypoglycemia-related healthcare utilization were significantly favorable for GLA-300." In addition, patients taking GLA-300 had significantly less days in hospital due to all-cause, diabetes, and hypoglycemia-related causes during the follow-up period vs. patients switching to other basal insulins. 

Findings from the study showed a lower hypoglycemia risk associated with lower healthcare resource utilization, including inpatient visits, ED visits, and associated cost. Switching basal insulins to GLA-300 vs. other basal insulins showed similarly improved glycemic control but with significantly lower risk of hypoglycemia for type 2 diabetes patients with high A1c levels in clinical settings.

"These results demonstrate that basal insulin therapy that delivers improved control with lower hypoglycemia risk and lower healthcare resource utilization and costs may have important relevance and implications for patients, providers, and payers," concluded Zhou.

For continuous endocrine news coverage from the AACE 2017 Annual Meeting, check back to MPR's AACE page for the latest updates.