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Basal and Bolus Insulin Dose Changes after Switching Basal Insulin to Insulin Degludec in Patients with Type 1 Diabetes Mellitus: A Pilot Study

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Abstract

Background and objectives

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.

Methods

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.

Results

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.

Conclusion

DEG improved glycemic control when switched from once-daily BI and maintained glycemic control when switched from twice-daily BI without increasing hypoglycemia.

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Acknowledgements

The Center for Diabetes and Endocrinology, Kitano Hospital receives financial support from Novo Nordisk Pharma, MSD Pharmaceutical, Novartis Pharma, Daiichi-Sankyo, and Astellas Pharma. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Some of the results described herein were presented at the annual scientific meeting of the American Diabetes Association in 2014.

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Author notes

  1. Yoshiyuki Hamamoto

    Present address: Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital, Osaka, 553-0003, Japan

Authors and Affiliations

  1. Center for Diabetes and Endocrinology, The Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, Osaka, Japan

    Yoshiyuki Hamamoto, Sachiko Honjo, Kanta Fujimoto, Shinsuke Tokumoto, Hiroki Ikeda, Yoshiharu Wada & Hiroyuki Koshiyama

  2. Ikeda Hospital, Ikeda, Hyogo, Japan

    Hiroki Ikeda

Authors
  1. Yoshiyuki Hamamoto
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  2. Sachiko Honjo
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  3. Kanta Fujimoto
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  4. Shinsuke Tokumoto
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  5. Hiroki Ikeda
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  7. Hiroyuki Koshiyama
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Corresponding author

Correspondence to Yoshiyuki Hamamoto.

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Funding

No external source of funding was used to conduct this research.

Conflict of interest

YH has received speaker’s fees from Novo Nordisk Pharma. The other authors declare that they have no conflict of interests. No other potential conflicts of interest relevant to this study exist.

Ethical approval

This study was approved by the ethics committee of our institute and all procedures performed in studies involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

All participants provided informed consent upon study enrollment.

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Hamamoto, Y., Honjo, S., Fujimoto, K. et al. Basal and Bolus Insulin Dose Changes after Switching Basal Insulin to Insulin Degludec in Patients with Type 1 Diabetes Mellitus: A Pilot Study. Clin Drug Investig 37, 845–852 (2017). https://doi.org/10.1007/s40261-017-0541-0

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  • DOI: https://doi.org/10.1007/s40261-017-0541-0

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