Comparison of Insulin Glargine 300 Units/mL and 100 Units/mL in Adults With Type 1 Diabetes: Continuous Glucose Monitoring Profiles and Variability Using Morning or Evening Injections

Author:

Bergenstal Richard M.1,Bailey Timothy S.2,Rodbard David3,Ziemen Monika4,Guo Hailing5,Muehlen-Bartmer Isabel4,Ahmann Andrew J.6

Affiliation:

1. Park Nicollet International Diabetes Center, Minneapolis, MN

2. AMCR Institute, Escondido, CA

3. Biomedical Informatics Consultants LLC, Potomac, MD

4. Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany

5. BDM Consulting Inc., Somerset, NJ

6. Oregon Health & Science University, Portland, OR

Abstract

OBJECTIVE The objective of this study was to compare glucose control in participants with type 1 diabetes receiving insulin glargine 300 units/mL (Gla-300) or glargine 100 units/mL (Gla-100) in the morning or evening, in combination with mealtime insulin. RESEARCH DESIGN AND METHODS In this 16-week, exploratory, open-label, parallel-group, two-period crossover study (clinicaltrials.gov identifier NCT01658579), 59 adults with type 1 diabetes were randomized (1:1:1:1) to once-daily Gla-300 or Gla-100 given in the morning or evening (with crossover in the injection schedule). The primary efficacy end point was the mean percentage of time in the target glucose range (80–140 mg/dL), as measured using continuous glucose monitoring (CGM), during the last 2 weeks of each 8-week period. Additional end points included other CGM glycemic control parameters, hypoglycemia (per self-monitored plasma glucose [SMPG]), and adverse events. RESULTS The percentage of time within the target glucose range was comparable between the Gla-300 and Gla-100 groups. There was significantly less increase in CGM-based glucose during the last 4 h of the 24-h injection interval for Gla-300 compared with Gla-100 (least squares mean difference −14.7 mg/dL [95% CI −26.9 to −2.5]; P = 0.0192). Mean 24-h glucose curves for the Gla-300 group were smoother (lower glycemic excursions), irrespective of morning or evening injection. Four metrics of intrasubject interstitial glucose variability showed no difference between Gla-300 and Gla-100. Nocturnal confirmed (<54 mg/dL by SMPG) or severe hypoglycemia rate was lower for Gla-300 participants than for Gla-100 participants (4.0 vs. 9.0 events per participant-year; rate ratio 0.45 [95% CI 0.24–0.82]). CONCLUSIONS Less increase in CGM-based glucose levels in the last 4 h of the 24-h injection interval, smoother average 24-h glucose profiles irrespective of injection time, and reduced nocturnal hypoglycemia were observed with Gla-300 versus Gla-100.

Funder

Sanofi

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

Reference17 articles.

1. Hypoglycaemia: the limiting factor in the glycaemic management of type I and type II diabetes;Cryer;Diabetologia,2002

2. New insulin glargine 300 units · mL−1 provides a more even activity profile and prolonged glycemic control at steady state compared with insulin glargine 100 units · mL−1;Becker;Diabetes Care,2015

3. Low within- and between-day variability in exposure to new insulin glargine 300 U/ml;Becker;Diabetes Obes Metab,2015

4. Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia;Workgroup on Hypoglycemia, American Diabetes Association;Diabetes Care,2005

5. New and improved methods to characterize glycemic variability using continuous glucose monitoring;Rodbard;Diabetes Technol Ther,2009

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