Evaluating risk of low blood sugar in patients with diabetes taking insulin degludec

This study evaluated the safety and effectiveness of switching to insulin degludec (Tresiba) in patients with diabetes mellitus. This study concluded that patients had better blood glucose control and a lower risk of low blood sugar after switching.

Insulin therapy is the typical first-line treatment for patients with diabetes mellitus. There are two types of insulin therapy. Basal insulin is slow-acting, so it helps keep insulin levels stable all day. Bolus insulin is fast-acting, so it is usually recommended around mealtimes to prevent blood glucose spikes.

Long-term use of insulin is associated with hypoglycemia (HG). This occurs when blood glucose levels are too low. Insulin degludec is a very long-acting basal insulin. Previous studies suggest that insulin degludec lowers the risk of HG. Whether patients switching from other types of basal insulin to insulin degludec also have a lower risk of HG is unclear.

556 patients had Type 1 diabetes (T1D) and 611 patients had Type 2 diabetes (T2D). 19.2% of patients with T1D and 16.4% of patients with T2D had well-controlled sugar levels (less than 7%). More than half of the patients in each group were considered at risk for an episode of HG (68.2% for T1D, 56.6% for T2D). Patients continued taking their previous basal insulin for 4 weeks before switching to insulin degludec. Patients were followed for an average of 12 months.

Overall, insulin degludec lowered the risk of HG by 20% for patients with T1D and by 54% for patients with T2D. The risk of severe HG also decreased by 72% (T1D) and 49% (T2D).

HbA1c is a measure of average blood glucose levels over the past 3 months. Among patients with T1D, the average HbA1c decreased from 8.1% to 7.8% with insulin degludec. Among patients with T2D, the average HbA1c decreased from 8.2% to 7.8% with insulin degludec. 

Among patients with T1D, switching to insulin degludec also helped lower insulin doses. The average daily basal insulin dose significantly decreased from 25.0 units per day to 22.8 units per day. The average daily bolus insulin dose significantly decreased from 27.3 units per day to 23.8 units per day. There was no decrease in insulin dose for patients with T2D.

The authors found that patients had a lower risk of HG and better blood glucose control after switching to insulin degludec.

Three of the authors of this study are full-time employees of Novo Nordisk, the manufacturer of insulin degludec. This study also had a short follow-up period. More studies are needed to confirm these results.

Talk to your doctor about the potential benefits of switching to insulin degludec.