Skip to main content

Advertisement

SpringerLink
Log in

Adjustment of insulin doses when switching from glargine 100 U/ml or detemir to degludec: an observational study

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Background

Degludec is a long-acting insulin with a longer duration of action and a greater day-to-day reproducibility of absorption in comparison with previous long-acting insulin formulations. The aim is the definition of the change in insulin needs in patients switching from detemir/glargine to degludec in real-life conditions.

Methods

In this retrospective cohort observational study, all outpatients with either type 1 or type 2 diabetes, starting therapy with degludec insulin—after a prior treatment with either detemir or glargine insulin for at least 6 months—were included.

Results

The analysis was performed on 266 patients, 172 and 96 with type 1 and type 2 diabetes, respectively. The equations describing the relationship between baseline and follow-up doses of basal insulin (6 months) were Y = 3.39 + 0.78X and Y = 0.44 + 0.69X, in patients receiving detemir/glargine either once or twice daily, respectively (Y = degludec dose at 6 months and X = basal insulin dose at switch). The corresponding equations for prandial insulin doses were y = 1.83 + 0.83*x and y = 2.85 + 0.80*x for those on pre-switch once or twice-daily basal insulin, respectively. In type 2 diabetes, the switch was associated with a reduction of basal insulin doses only in those with a prior twice-daily treatment with basal insulin. The reduction of prandial insulin reached statistical significance only in patients previously treated with basal insulin once daily.

Conclusions

The present results provide a suggestion for a simple method for the adjustment of basal and prandial insulin doses in type 1 diabetic patients, switching from glargine or detemir to degludec.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Pettus J, Santos Cavaiola T, Tamborlane WV, Edelman S (2016) The past, present, and future of basal insulins. Diabetes Metab Res Rev 32:478–496

    Article  PubMed  CAS  Google Scholar 

  2. Heise T, Hermanski L, Nosek L, Feldman A, Rasmussen S, Haahr H (2012) Insulin degludec: four times lower pharmacodynamics variability than insulin glargine under steady-state conditions in type 1 diabetes. Diabetes Obes Metab 14:859–864

    Article  PubMed  CAS  Google Scholar 

  3. Heise T, Nosek L, Bøttcher SG, Hastrup H, Haahr H (2012) Ultra-long-acting insulin degludec has a flat and stable glucose-lowering effect in type 2 diabetes. Diabetes Obes Metab 14:944–950

    Article  PubMed  CAS  Google Scholar 

  4. Ratner RE, Gough SC, Mathieu C, Del Prato S, Bode B, Mersebach H, Endahl L, Zinman B (2013) Hypoglycaemia risk with insulin degludec compared with insulin glargine in type 2 and type 1 diabetes: a pre-planned meta-analysis of phase3 trials. Diabetes Obes Metab 15:175–184

    Article  PubMed  CAS  Google Scholar 

  5. Monami M, Mannucci E (2013) Efficacy and safety of degludec insulin: a meta-analysis of randomised trials. Curr Med Res Opin 29:339–342

    Article  PubMed  CAS  Google Scholar 

  6. Vora J, Christensen T, Rana A, Bain SC (2014) Insulin degludec versus insulin glargine in type 1 and type 2 diabetes mellitus: a meta-analysis of endpoints in phase 3a trials. DiabetesTher 5:435–446

    CAS  Google Scholar 

  7. Dżygało K, Golicki D, Kowalska A, Szypowska A (2015) The beneficial effect of insulin degludec on nocturnal hypoglycaemia and insulin dose in type 1 diabetic patients: a systematic review and meta-analysis of randomised trials. Acta Diabetol 52:231–238

    Article  PubMed  CAS  Google Scholar 

  8. Birkeland KI, Home PD, Wendisch U, Ratner RE, Johansen T, Endahl LA, Lyby K, Jendle JH, Roberts AP, DeVries JH, Meneghini LF (2011) Insulin degludec in type 1 diabetes: a randomized controlled trial of a new-generation ultra-long-acting insulin compared with insulin glargine. Diabetes Care 34:661–665

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bode BW, Buse JB, Fisher M, Garg SK, Marre M, Merker L, Renard E, Russell-Jones DL, Hansen CT, Rana A, Heller SR, BEGIN® Basal-Bolus Type 1 trial investigators (2013) Insulin degludec improves glycaemic control with lower nocturnal hypoglycaemia risk than insulin glargine in basal-bolus treatment with mealtime insulin aspart in Type 1 diabetes (BEGIN(®) Basal-Bolus Type 1): 2-year results of a randomized clinical trial. Diabet Med 30:1293–1297

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Davies MJ, Gross JL, Ono Y, Sasaki T, Bantwal G, Gall MA, Niemeyer M, Seino H, BEGIN BB T1 Study Group (2014) Efficacy and safety of insulin degludec given as part of basal-bolus treatment with mealtime insulin aspart in type 1 diabetes: a 26-week randomized, open-label, treat-to-target non-inferiority trial. Diabetes Obes Metab 16:922–930

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Kalra S (2013) Insulin degludec: a significant advancement in ultralong-acting Basal insulin. Diabetes Ther 4:167–173

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Kaku K, Wolden ML, Hyllested-Winge J, Nørtoft E (2017) Insulin degludec in clinical practice: a review of Japanese real-world data. Diabetes Ther 8:189–195

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Galasso S, Facchinetti A, Bonora BM, Mariano V, Boscari F, Cipponeri E, Maran A, Avogaro A, Fadini GP, Bruttomesso D (2016) Switching from twice-daily glargine or detemir to once-daily degludec improves glucose control in type 1 diabetes. An observational study. Nutr Metab Cardiovasc Dis 26:1112–1119

    Article  PubMed  CAS  Google Scholar 

  14. Heller S, Buse J, Fisher M, Garg S, Marre M, Merker L, Renard E, Russell-Jones D, Philotheou A, Francisco AM, Pei H, Bode B, BEGIN Basal-Bolus Type 1 Trial Investigators (2012) Insulin degludec, an ultra-longacting basal insulin, versus insulin glargine in basal-bolus treatment with mealtime insulin aspart in type 1 diabetes (BEGIN Basal-Bolus Type 1): a phase 3, randomised, open-label, treat-to-target non-inferiority trial. Lancet 379:1489–1497

    Article  PubMed  CAS  Google Scholar 

  15. Mathieu C, Hollander P, Miranda-Palma B, Cooper J, Franek E, Russell-Jones D, Larsen J, Tamer SC, Bain SC, NN1250-3770 (BEGIN: Flex T1) Trial Investigators (2013) Efficacy and safety of insulin degludec in a flexible dosing regimen vs insulin glargine in patients with type 1 diabetes (BEGIN: Flex T1): a 26-week randomized, treat-to-target trial with a 26-week extension. J Clin Endocrinol Metab 98:1154–1162

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Meneghini L, Atkin SL, Gough SC, Raz I, Blonde L, Shestakova M, Bain S, Johansen T, Begtrup K, Birkeland KI, NN1250-3668 (BEGIN FLEX) Trial Investigators (2013) The efficacy and safety of insulin degludec given in variable once-daily dosing intervals compared with insulin glargine and insulin degludec dosed at the same time daily: a 26-week, randomized, open-label, parallel-group, treat-to-target trial in individuals with type 2 diabetes. Diabetes Care 36:858–864

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Zinman B, Philis-Tsimikas A, Cariou B, Handelsman Y, Rodbard HW, Johansen T, Endahl L, Mathieu C, NN1250-3579 (BEGIN Once Long) Trial Investigators (2012) Insulin degludec versus insulin glargine in insulin-naive patients with type 2 diabetes: a 1-year, randomized, treat-to-target trial (BEGIN Once Long). Diabetes Care 35:2464–2471

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Komuro M, Inoue G, Tabata M, Yamada Y, Atsuda K, Matsubara H, Irie J, Uchida J, Nakajima C, Izumi H, Shimada M, Yamada S (2015) Insulin degludec requires lower bolus insulin doses than does insulin glargine in Japanese diabetic patients with insulin-dependent state. J Diabetes Sci Technol 9:632–638

    Article  PubMed  CAS  Google Scholar 

  19. Simon AC, Schopman JE, Hoekstra JB, Abu-Hanna A, Gerdes VE, Peek N, Holleman F (2015) Factors that drive insulin-dosing decisions of diabetes care providers: a vignette-based study in the Netherlands. Diabet Med 32:69–77

    Article  PubMed  CAS  Google Scholar 

  20. Goldman J, Kapitza C, Pettus J, Heise T (2017) Understanding how pharmacokinetic and pharmacodynamic differences of basal analog insulins influence clinical practice. Curr Med Res Opin 33:1821–1831 (Epub ahead of print)

    Article  PubMed  CAS  Google Scholar 

  21. Heise T, Hövelmann U, Nosek L, Hermanski L, Bøttcher SG, Haahr H (2015) Comparison of the pharmacokinetic and pharmacodynamic profiles of insulin degludec and insulin glargin. Expert Opin Drug Metab Toxicol 11:1193–1201

    Article  PubMed  CAS  Google Scholar 

  22. Porcellati F, Rossetti P, Busciantella NR, Marzotti S, Lucidi P, Luzio S, Owens DR, Bolli GB, Fanelli CG (2007) Comparison of pharmacokinetics and dynamics of the long-acting insulin analogs glargine and detemir at steady state in type 1 diabetes: a double-blind, randomized, crossover study. Diabetes Care 30:2447–2452

    Article  PubMed  CAS  Google Scholar 

  23. Shimoda S, Sato M, Sekigami T, Motoshima H, Yoshimura R, Fukuda K, Matsuo Y, Noda H, Okubo M, Ichimori S, Fujisawa K, Fukunaga M, Araki E, Kumamoto Insulin Degludec Observational (KIDUNA) Study Group (2016) A 1-year, prospective, observational study of Japanese outpatients with type 1 and type 2 diabetes switching from insulin glargine or detemir to insulin degludec in basal-bolus insulin therapy (Kumamoto Insulin Degludec Observational study). J Diabetes Investig 7:703–710

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Kusunoki Y, Katsuno T, Miyakoshi K, Ikawa T, Nakae R, Ochi F, Tokuda M, Akagami T, Murai K, Miuchi M, Hamaguchi T, Miyagawa J, Namba M (2013) Effects of switching from insulin glargine or detemir to insulin degludec in patients with type 1 diabetes mellitus. Diabetes Ther 4:461–472

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Bohn B, Zimmermann A, Wagner C, Merger S, Dunstheimer D, Kopp F, Gollisch K, Zindel V, Holl RW, DPV DPV (2017) Real-life experience of patientsstarting insulindegludec. A multicenteranalysis of 1064 subjects from the German/Austrian DPV registry. Diabetes Res Clin Pract 129:52–58

    Article  PubMed  CAS  Google Scholar 

  26. Dornhorst A, Lüddeke HJ, Sreenan S (2007) Safety and efficacy of insulin detemir in clinical practice: 14-week follow-up data from type 1 and type 2 diabetes patients in the PREDICTIVE European cohort. Int J Clin Pract 61:523–528

    Article  PubMed  CAS  Google Scholar 

  27. Porcellati F, Rossetti P, Busciantella NR, Marzotti S, Lucidi P, Luzio S, Owens DR, Bolli GB, Fanelli CG (2007) Comparison of pharmacokinetics and dynamics of the long-acting insulin analogs glargine and detemir at steady state in type 1 diabetes: a double-blind, randomized, crossover study. Diabetes Care 30:2447–2452

    Article  PubMed  CAS  Google Scholar 

  28. Urakami T, Kuwabara R, Habu M, Komiya K, Nagano N et al (2012) Comparison of the injection frequencies employed and basal-to-total insulin dose ratios obtained when glargine and detemir are used in children with type 1 diabetes mellitus treated by basal-bolus therapy. Diabetol Int 3:75–79

    Article  Google Scholar 

Download references

Funding

This research was performed independently of any funding, as part of the institutional activity of the investigators.

Author information

Authors and Affiliations

  1. Diabetology, Azienda Ospedaliero Universitaria Careggi and University of Florence, 50141, Florence, Italy

    C. Lualdi, A. Silverii, I. Dicembrini, L. Pala, M. Monami & E. Mannucci

Authors
  1. C. Lualdi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Silverii
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. Dicembrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Pala
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Monami
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Mannucci
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CL, AS, ID, and LP were involved in each of the following points: (1) data collection, (2) writing manuscript, and (3) manuscript revision. MM and EM were involved in each of the following points: (1) design; (2) analysis; (3) writing manuscript; and (4) Manuscript revision.

Corresponding author

Correspondence to E. Mannucci.

Ethics declarations

All the authors approved the final version of this manuscript. Dr. Edoardo Mannucci is the person who takes full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript

Conflict of interest

The authors have no relevant conflicts of interest to declare with the exception of MM and EM: Dr. Matteo Monami (MM) and Prof. Edoardo Mannucci (EM) have received grant/speaking fees from Astra, Boehringer, MSD, Takeda, Jannsen, Sanofi, Nobonordisk, and Lilly.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Informed consent was obtained from all patients for being included in the study.

Human and animal rights

This article does not contain any studies with animal subjects.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lualdi, C., Silverii, A., Dicembrini, I. et al. Adjustment of insulin doses when switching from glargine 100 U/ml or detemir to degludec: an observational study. J Endocrinol Invest 42, 319–326 (2019). https://doi.org/10.1007/s40618-018-0920-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-018-0920-2

Keywords

Search

Navigation