Switching from Glargine to Degludec is not associated with an overt change in glucose control in a cohort of patients with type 1 diabetes: a CGM analysis

Excerpt

After DCCT, intensive multiple daily insulin injections protocol became the standard therapy for patients with T1DM intended to maintain a lower HbA1c without hypoglycemia and thus to decrease the risk of microvascular complications. Design and production of new basal insulin analogs with lower risk of hypoglycemia was the next challenge. The switch from NPH to the basal insulin analog Glargine represented a major clinical advantage allowing to obtain a better and safer glucose control. Degludec is a new basal insulin analog with longer half-life and lower variability than Glargine [1]. Despite these differences, clinical trials comparing Glargine and Degludec in patients with T1DM and T2DM have failed to show a clear clinical advantage of Degludec in both efficacy and safety. A statistically significant lower number of hypoglycemic events, associated with Degludec versus Glargine, have been shown only in patients at high risk of hypoglycemia and intensively treated (HbA1c < 7%), an uncommon scenario. The clinical meaning of these trials is flawed also by the small number of hypoglycemic events, often self-reported by patients. It should be noted that some patients reported hypoglycemia more than once [2‐5]. Few trials have utilized CGM to detect differences between Glargine and Degludec, again results were not informative since Degludec was compared to patients treated either with Glargine or Detemir [1, 4, 5]. …