Predicted rates of hypoglycemia with Gla-300 versus basal insulin analogs

Predicted rates of hypoglycemia with Gla-300 versus basal insulin analogs

January 12, 2020 0 By Jose Scott


Hypoglycemia, or low blood glucose, is an
important risk factor for people with type 2 diabetes receiving blood glucose-lowering
therapies, such as insulin. It can lead to symptoms that interfere with
activities of daily living and can sometimes (though rarely) result in debilitating events,
including loss of consciousness. Basal insulins are designed to help maintain
stable blood glucose levels throughout the day. Data from randomized clinical trials show
that newer, second-generation basal insulin analogs (such as insulin glargine 300 units
per mL and insulin degludec) have lower hypoglycemia risk than first-generation basal insulin analogs
(such as insulin glargine 100 units per mL and insulin detemir), while providing comparable
glycemic control. However, these randomized controlled trials
may not truly reflect clinical practice, as they applied strict inclusion and exclusion
criteria and were conducted under strict oversight dictated by very specific protocols. Real-world studies look at what happens in
day-to-day clinical practice. The LIGHTNING study analyzed real-life data
from electronic health records to predict rates of severe hypoglycemia for different
basal insulins in adults with type 2 diabetes. The researchers accounted for confounders
in this loosely structured dataset by performing two different analyses: propensity score matching,
which compares cohorts matched according to clinical characteristics, and a more advanced
predictive-modeling approach based on machine learning, which is detailed in an accompanying
article. Predictive-modeling results suggest that,
among first-time insulin users, glargine 300 would lead to 50% lower rates of severe hypoglycemia
compared with the first-generation basal insulin analogs: 1 event every 14 years versus 1 every
7 years. Meanwhile, compared with those switching to
insulin detemir from another basal insulin analog, patients switching to glargine 300
could expect 30% lower rates of severe hypoglycemia: 1 event every 5 years instead of 1 every 3
years. Similar rates of severe hypoglycemia were
predicted for both second-generation basal insulins, glargine 300 and degludec, regardless
of whether patients had previously used basal insulin. These predictive-modeling findings agree with
the propensity score matching results and are also generally consistent with those of
randomized controlled trials and other real-world studies. More work is needed to explore the predicted
effects, as the models used simplify the complex factors that determine the real-life risk
of hypoglycemia. But these results, based on real data from
patients in clinical practice, are encouraging and could help patients and healthcare providers
make more informed decisions about basal insulin treatment options for people with type 2 diabetes.