Which type of insulin is best for avoiding hypoglycemia in patients with high risk type 2 diabetes?

This study compared the risk of hypoglycemia (dangerously low blood glucose levels) for insulin glargine 300 U/ml (Gla-300; Toujeo) and standard-of-care basal insulin (SOC-BI) at patients with type 2 diabetes (T2D) with risk factors for hypoglycemia. It found that Gla-300 was associated with a lower risk of hypoglycemia than SOC-BI.

Patients with T2D often need insulin treatment to improve their blood glucose (sugar) control. However, insulin can lead to episodes of hypoglycemia, which can be dangerous. Patients who have never had insulin treatment before are described as insulin-naive. Patients can have risk factors that increase their risk of hypoglycemia. These risk factors include age over 65, chronic kidney disease, heart disease, a history of hypoglycemia, dementia, or blindness.  

There are different types of insulin treatment available. Standard-of-care basal insulin (SOC-BI) is the most common treatment. It involves either insulin glargine 100 U/ml (Gla-100; Lantus) or insulin detemir (Levemir). A more recent treatment involves insulin glargine 300 U/ml (Gla-300). It is not clear which of these treatments carries the lowest risk of hypoglycemia.  

This study involved 2,047 insulin-naive patients with T2D and one or more risk factors for hypoglycemia. 1,057 patients received Gla-300, 990 patients received SOC-BI. Patients were monitored for hypoglycemia.  

Overall, patients were less likely to develop hypoglycemia when treated with Gla-300 than with SOC-BI. Patients aged over 65 were 52% less likely to have hypoglycemia on Gla-300 treatment than on SOC-BI treatment. Patients with chronic kidney disease were 2.28 times less likely to have hypoglycemia on Gla-300 than on SOC-BI treatment. 

This study showed that Gla-300 is less likely than SOC-BI to cause hypoglycemia in high-risk patients with T2D.

This study was funded by Sanofi, the manufacturer of Gla-300.