Greater Reductions in HbA1c in Insulin-Naïve PW2D Treated with Gla-300

Timothy Bailey, MD

New data from California suggested that the treatment with insulin glargine 300 units/mL (Gla-300) in insulin-naïve patients with type 2 diabetes (T2D) resulted in slightly greater but statistically insignificant reductions in hemoglobin A1C (HbA1c).

A similar occurrence with hypoglycemia was also recorded.

The study was presented this week at the 19th Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease Meeting.

Though investigators noted that insulin had been commonly used in patients with type 2 diabetes with renal impairment, it is also associated with risk of hypoglycemia, which could hinder glycemic control.

As such, Timothy Bailey, MD, AMCR Institute, Escondido, California, and a team of investigators compared real-world clinical outcomes in patients with type 2 diabetes with renal impairment receiving either Gla-300 or insulin degludec (IDeg).

The Methods

The investigators monitored insulin-naïve adults patients with T2D and renal impairment who received Gla-300 or IDeg between March 1, 2015 and August 31, 2019.

Study participants were identified using electronic medical records from ICM Explorys in the United States, with the index data acting as the first prescription of either Gla-300 or IDeg during the identification period.

All eligible participants were required to have ≥1 diagnosis of type 2 diabetes (identified using International Classification of Diseases, 9th/10th Revision), emergency medical record data for 12 months or more before index (“baseline”) and months or more after index (“follow-up”), an estimated glomerular filtration rate of 15–60 mL/min/1.73 m2, and a history of oral antidiabetic medication or glucagon-like peptide-1 receptor agonist use before index.

Once all eligible participants were identified, the 2 cohort groups were propensity-score matched on baseline characteristics.

A total of 784 participants with TD2 were identified during the study, with 461 belonging to the Gla-300 cohort and 323 belonging to the IDeg cohort. However, after matching 300 patients remained in each cohort.

For their statistical analysis, baseline characteristics were analyzed while means and standard deviations (SDs) were provided for continuous variables. Logistic regression, student’s t-test, and generalized linear model were also used to compare outcomes in the 2 cohorts.

The Results

Bailey and investigators noted that baseline characteristics were similar between the 2 cohorts, with male participants making up roughly half of each cohort (51.3% vs. 49.7%). The mean age was 68.2 years for the Gla-300 group and 68.4 years for the IDeg group.

Regarding HbAIc reductions, values decreased significantly during the 6-month follow-up period in both the Gla-300 (baseline: 9.34% vs. 6 months: 7.89%; P<0.001).

Reduction in HbA1c at the 6-month follow-up was statistically significant in both subgroups receiving Gla-300 when stratified by baseline HbA1c. r=Reduction in HbA1c in PWD2 receiving IDeg was significant in the >9% subgroup, though not in the ≤9% subgroup.

At the conclusion of the 6-month follow-up period, patients receiving Gla-300 and IDeg had comparable HbA1c goal attainment with similar proportions achieving the target of of <7% and <8%.

Overall, investigators reported that the second-generation basal insulin Gla-300 and IDeg were associated with improved glycemic outcomes compared to first-generation basal insulin in this patient population.

“This study showed that in insulin-naïve PWD2 with renal impairment, Gla-300 demonstrated a trend towards slightly greater, but not statistically significant, reductions in HbA1c,” the team wrote.

“Real-world outcomes in people with type 2 diabetes (PWD2) and renal impairment receiving insulin glargine 300 U/mL (Gla-300) and insulin degludec 100U/mL or 200U/mL (IDeg): the DELIVER-R study,” was published online by WCIRDC.