Switching Basal Insulin Analogues: The Real-World Clinical Outcomes

the MPR take:

Many studies have evaluated the efficacy and safety of insulin glargine (GLA) and insulin detemir (DET) in treating type 2 diabetes mellitus (T2DM), but assessing real-world clinical outcomes on switching basal insulin analogues among T2DM patients can be challenging. This retrospective cohort study of T2DM included the following 13,942 patients ages ≥18 years: those who were previously treated with GLA and switched to DET, those who remained on GLA, those who were previously treated with DET and switched to GLA, and those who remained on DET. Data from the one-year follow-up showed that switching from GLA to DET resulted in lower persistence with treatment, compared to a higher persistence seen in those switching from DET to GLA. Patients who remained on GLA had better clinical outcomes at one-year follow-up compared to those who switched from GLA to DET, including lower HbA1c levels and significantly higher HbA1c reductions. Patients who switched from DET to GLA had lower HbA1c levels but a non-significant HbA1c reduction compared to those who remained on DET. Persistence was greater in those patients who remained on GLA vs. those who switched to DET, although this could be due to DET requiring administration twice daily compared to once daily with GLA. Maintaining patients on GLA or switching from DET to GLA may be beneficial but could result in minor weight gain; the authors note that the two basal insulin analogues may not be therapeutically interchangeable and additional investigations are needed.

To evaluate real-world clinical outcomes for switching basal insulin analogues [insulin glargine (GLA) and insulin detemir (DET)] among US patients with type 2 diabetes mellitus (T2DM).