Thrice-weekly novel insulin effectively controls glucose

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Degludec, a new longer-acting form of insulin, was just as effective at controlling blood sugar when administered in once-daily and thrice-weekly regimens as existing once-daily insulin glargine injections, results of a phase-2 clinical trial published in Lancet indicate.

“This new basal insulin analogue might be valuable addition to clinical practice,” study researcher Bernard Zinman, MD, a professor at the Samuel Lunenfeld Research Institute at Mount Sinai Hospital and the University of Toronto in Ontario, Canada, said in a press release.

Zinman and colleagues enrolled 245 patients aged 18 to 75 years who type 2 diabetes and glycosylated hemoglobin (HbA1c) levels of 7% to 11%. The trial involved patients from 28 sites in Canada, India, South Africa and the United States. Patients were randomly assigned to receive insulin degludec either once a day or three times a week, or insulin gargline once a day.

At study end HbA1c levels were similar across treatment groups ranging from 7.2% to 7.5%; however, fewer patients in the once-daily insulin degludec group had hypoglycemia compared with the other groups. Adverse event rates were similar among all groups.

“The safety, efficacy and optimum use of treatment regimens for insulin degludec will need to be established in larger phase 3 trials,” Zinman said.

Yogish C. Kudva, MD, and Ananda Basu, MD, of the Mayo Clinic College of Medicine in Rochester, Minn., praised the new therapy in an accompanying editorial, noting that the thrice-weekly insulin degludec dosing schedule has the potential to improve medication adherence and glycemic control while causing less disruption in patients' lives.

However, they also pointed out that as people with type 2 diabetes live longer, their risk for developing other comorbid conditions, such as cancer, also increases. “Although the evidence is much debated, high circulating concentrations of insulin might increase the risk of neoplasia, an effect referred to as the insulin supply hypothesis.”

Kudva and Basu emphasized the importance of lifestyle changes such as diet and exercise as in expensive and effective ways to control glucose, but noted that these methods “need constant reemphasis.”

“This option is not often thought about but needs resurrection, even as the numbers of long-acting drugs for type 2 diabetes increase,” they wrote.

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