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Adjustment of insulin doses when switching from glargine 100 U/ml or detemir to degludec: an observational study

  • C. Lualdi
  • A. Silverii
  • I. Dicembrini
  • L. Pala
  • M. Monami
  • E. Mannucci
Original Article
  • 163 Downloads

Abstract

Background

Degludec is a long-acting insulin with a longer duration of action and a greater day-to-day reproducibility of absorption in comparison with previous long-acting insulin formulations. The aim is the definition of the change in insulin needs in patients switching from detemir/glargine to degludec in real-life conditions.

Methods

In this retrospective cohort observational study, all outpatients with either type 1 or type 2 diabetes, starting therapy with degludec insulin—after a prior treatment with either detemir or glargine insulin for at least 6 months—were included.

Results

The analysis was performed on 266 patients, 172 and 96 with type 1 and type 2 diabetes, respectively. The equations describing the relationship between baseline and follow-up doses of basal insulin (6 months) were Y = 3.39 + 0.78X and Y = 0.44 + 0.69X, in patients receiving detemir/glargine either once or twice daily, respectively (Y = degludec dose at 6 months and X = basal insulin dose at switch). The corresponding equations for prandial insulin doses were y = 1.83 + 0.83*x and y = 2.85 + 0.80*x for those on pre-switch once or twice-daily basal insulin, respectively. In type 2 diabetes, the switch was associated with a reduction of basal insulin doses only in those with a prior twice-daily treatment with basal insulin. The reduction of prandial insulin reached statistical significance only in patients previously treated with basal insulin once daily.

Conclusions

The present results provide a suggestion for a simple method for the adjustment of basal and prandial insulin doses in type 1 diabetic patients, switching from glargine or detemir to degludec.

Keywords

Type 1 diabetes Type 2 diabetes Insulin Degludec Basal insulin Prandial insulin 

Notes

Author contributions

CL, AS, ID, and LP were involved in each of the following points: (1) data collection, (2) writing manuscript, and (3) manuscript revision. MM and EM were involved in each of the following points: (1) design; (2) analysis; (3) writing manuscript; and (4) Manuscript revision.

Funding

This research was performed independently of any funding, as part of the institutional activity of the investigators.

Compliance with ethical standards

All the authors approved the final version of this manuscript. Dr. Edoardo Mannucci is the person who takes full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript

Conflict of interest

The authors have no relevant conflicts of interest to declare with the exception of MM and EM: Dr. Matteo Monami (MM) and Prof. Edoardo Mannucci (EM) have received grant/speaking fees from Astra, Boehringer, MSD, Takeda, Jannsen, Sanofi, Nobonordisk, and Lilly.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Informed consent was obtained from all patients for being included in the study.

Human and animal rights

This article does not contain any studies with animal subjects.

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Copyright information

© Italian Society of Endocrinology (SIE) 2018

Authors and Affiliations

  • C. Lualdi
    • 1
  • A. Silverii
    • 1
  • I. Dicembrini
    • 1
  • L. Pala
    • 1
  • M. Monami
    • 1
  • E. Mannucci
    • 1
  1. 1.DiabetologyAzienda Ospedaliero Universitaria Careggi and University of FlorenceFlorenceItaly

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