Treatment Strategies to Limit Hypoglycemia
Studies summarized in this slide show focus on fine-tuning insulin-containing regimens to enhance glucose control and avoid variability.
Treatment Strategies to Limit Hypoglycemia: 3 Studies At-a-Glance based on presentations at the American Diabetes Association 77th Scientific Sessions, June 9-13, 2017
Glycemic Variability in Metformin/DPP-4 Inhibitor Compared with the High-dose Metformin in Patients with Multiple-Daily-Insulin-Treated Type 2 Diabetes: A Prospective, Randomized, Controlled Trial
Oral antidiabetic adjuncts to multiple daily insulin (MDI) are compared on reducing glycemic variability, with expected reduction in associated hypoglycemia.
Conclusion:
The addition of a DPP-4 inhibitor to metformin as adjunct to MDI may be preferred to increasing MET dose as a strategy to increase glycemic control with less risk of glycemic variability and associated hypoglycemia.
Link to Abstract.
Comparison of Morning Insulin Glulisine + Insulin Glargine 300U/mL vs Insulin Lispro + Insulin Glargine Biosimilar Using Continuous Glucose Monitoring: A Randomized Crossover Study
Thirty patients with T2DM stabilized with morning long-acting and ultra-rapid insulins were randomized to 2 days of one regimen and cross-over to 2 days of the other, with continuous glucose monitoring.
Conclusion:
S regimen (insulin glulisine + insulin glargine 300U/mL) was superior to K regimen (insulin lispro + insulin glargine biosimilar) in decreasing post-breakfast glucose level, reducing rate of rise, nocturnal and 24-hour glucose level and glycemic variability, without hypoglycemia.
Link to Abstract.
Improved Glycemic Control and Lower Hypoglycemia Risk with Reduced Prior Oral Antidiabetes Drug (OAD) Therapy in Patients (pts) with T2D Treated with Insulin Glargine 300U/mL (Gla-300)
Patients with T2DM often require addition of basal insulin when hyperglycemia is no longer adequately controlled with oral antidiabetes drugs (OADs); current study evaluates whether initiating insulin allows reduction in OAD use without compromising impact on A1c
Use of 2 OADs vs 1 after 6 months on Gla-300 or Gla-100: 49 % using 2 meds rather than 1 at baseline; reduced to 8% after 6 months. Results consistent with real-world data (in N=6,430) where 39% on 2 OADs reduced to 23% at 6 months with Gla 300 or 100.
Conclusion:
Data suggest patients with poorly controlled T2DM on 2 OADs could step down to 1 by adding Gla-300 basal insulin, without sacrificing glycemic control and with less hypoglycemia than with Gla-100.
Link to Abstract.
Summarized in the slides above are studies presented at the ADA 77th Scientific Sessions that examined treatment regimen effects on glycemic control and variability, including comparisons of:⺠Different oral adjuncts to multiple daily insulin⺠Different morning insulins, and⺠Oral antidiabetic regimens before and after addition of basal insulin Links to meeting abstracts are provided in slide captions.
