Gupta S, et al. - Experts probed into the variations in dosing and clinical outcomes prior to and after insulin glargine at a strength of 300 units per milliliter (Gla-300) treatment initiation in patients with type 2 diabetes starting or switching to treatment with Gla-300. The intention was to examine if the benefits observed in clinical trials could be translated into real-world scenarios. When compared to patients starting Gla-100 therapy, insulin-naive patients starting Gla-300 treatment reported fewer hypoglycemic events, a similar hemoglobin A_1c level reduction and no change in insulin dose. Substantially lower daily doses of basal insulin (BI), fewer hypoglycemic events, without compromise of hemoglobin A_1c level reduction were illustrated among patients switching to Gla-300 treatment from treatment with other BIs. Hence, it was disclosed that Gla-300 imparted benefits with regard to dosing, with improved hemoglobin A_1c level and hypoglycemia rates, in a real-world setting.

Methods

• The plot of this research was a retrospective observational study.
• It was conducted by using medical record data obtained via physician survey for patients starting treatment with insulin glargine at a strength of 100 units per milliliter (Gla-100) or Gla-300, or switching to treatment with Gla-300 from treatment with another basal insulin (BI).
• Experts scrutinized the variations in dosing and clinical outcomes before vs after treatment initiation or switching through generalized linear mixed-effects models.

Results

• Among insulin-naive patients starting BI treatment, the final titrated dose did not exhibit any variation in patients starting Gla-300 treatment vs those starting Gla-100 treatment [least-squares (LS) mean 0.43 units per kilogram vs 0.44 units per kilogram; P=0.77].
• Prominent hemoglobin A_1c level reductions (LS mean 1.21 percentage points for Gla-300 and 1.12 percentage points for Gla-100 ; both P < 0.001) were noted among both groups.
• Data disclosed lower relative risk of hypoglycemic events after Gla-300 treatment initiation than that after Gla-100 treatment initiation [0.31, 95% confidence interval (CI) 0.12-0.81; P=0.018] at similar daily doses.
• It was determined that the daily dose of BI was markedly lower after switching to treatment with Gla-300 from treatment with another BI (0.73 units per kilogram before switch vs 0.58 units per kilogram after switch; P=0.02).
• After switching, the mean hemoglobin A_1c level was substantially lower than before switching (adjusted difference -0.95 percentage points, 95% CI -1.13 to -0.78 percentage points ; P < 0.0001).
• Moreover, findings revealed considerably lower hypoglycemic events per patient-year (relative risk 0.17, 95% CI 0.11-0.26; P < 0.0001).