Does insulin glargine-300 reduce the risk of hypoglycemia in patients with type 1 diabetes?

This study compared the risk of severe hypoglycemia (dangerously low blood glucose levels) with insulin glargine-100 (Lantus) and insulin glargine-300 (Toujeo) for patients with type 1 diabetes (T1D). It found that both medications improved glucose control, and insulin glargine-300 had a lower risk of hypoglycemia.

T1D is a condition in which the pancreas is unable to create the hormone insulin. Patients with T1D require injections of insulin to maintain normal levels of blood glucose. However, tightly controlling glucose levels increases the risk of hypoglycemia or abnormally low blood sugar. Severe hypoglycemia is a serious medical event.

There are multiple different types of synthetic insulin. Basal insulin lasts an extended period in the body can improve blood sugar stability. Insulin glargine is a commonly prescribed and effective type of basal insulin. There are two formulations of insulin glargine which have the same active ingredient. Insulin glargine-300 (glar-300) is three times as concentrated as insulin glargine-100 (glar-100). This more concentrated formulation causes the insulin glargine to be absorbed into the body more slowly. Glar-300 may lead to more stable blood glucose levels compared to glar-100. It is unclear whether glar-300 reduces the risk of hypoglycemia compared to glar-100.

This analysis combined the results of three similarly-designed studies using 1,255 patients with T1D. One study was conducted in Japan, and two were multinational. 351 patients were children and adolescents with T1D. All patients had been using both a basal insulin and a short-acting bolus insulin around mealtimes for at least a year. 629 patients were randomly assigned to glar-300, and 626 used glar-100. Patients were followed for 26 weeks.

Both groups experienced an improvement in blood glucose control after transitioning to insulin glargine. The improvement in glycated hemoglobin (HbA1c), which is an indication of blood sugar control over the previous two to three months, was similar in both groups.

The risk of an episode of hypoglycemia was 20% lower for patients taking glar-300 compared to glar-100. This significant reduction in risk occurred by the eighth week of taking glar-300. There were 70 total episodes of hypoglycemia in the glar-300 group, compared to 86 for the glar-100 group.

Similar numbers of patients experienced side effects in both groups.

This study found that glar-300 led to fewer episodes of hypoglycemia for patients with T1D, while maintaining glucose control.

This study was funded by Sanofi, the manufacturer of both Lantus and Toujeo. While the patent for Lantus has expired in Japan and the European Union, Toujeo is still under patent.