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Achieving FPG Target Without Hypoglycemia: A Meta-Analysis of Insulin Degludec vs. Insulin Glargine U100
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Abstracts / Can J Diabetes 40 (2016) S27–S74
With n=18, it correlated with the clamp increase in net Leu balance (r=0.555, p=0.017), signifying enhanced insulin-stimulated anabolism. Controlled for fasting insulin, this lost significance; hence, protein anabolism was mainly determined by insulin sensitivity. Results are consistent with adiponectin’s proposed role in: 1. regulating postabsorptive BCAAs, independent of associations with abdominal adiposity and insulin resistance, 2. suppressing BCAA catabolism. 152 Postprandial Hyperglycemia and Healthcare Resource Use KATHRYN M. PFEIFFER†, ANNIE NIKOLAJSEN†, JAMES WEATHERALL†, LARISA NURKANOVIC*,†, ARASH PAKSERESHT†, MERYL BROD† Mississauga, ON Postprandial hyperglycemia (PPH) among people with diabetes is a well-known challenge to diabetes management. While the impact of postprandial hypoglycemia on healthcare resource use has been well studied, little is known about the impact of PPH. This study aimed to assess the impact of respondent-reported PPH episodes on healthcare resource use among people with type 1 (T1D) or type 2 (T2D) diabetes using mealtime bolus insulin. Data were collected in an Internet survey of 906 adults with T1D (39%) or T2D (61%) treated with self-administered bolus insulin therapy, but not using pre-mixed insulin or GLP-1 analogues (with or without oral antidiabetic drugs), in Germany (34%), the UK (26%) and the USA (40%). Overall, 66% of respondents reported difficulty stabilizing postprandial blood glucose (BG) during the previous week, with 36% experiencing postprandial hypoglycemia and 62% experiencing PPH. Eleven per cent of respondents experienced postprandial hypoglycemia and 30% experienced PPH episodes ≥3 times in the previous week. Table 1 shows healthcare professional (HCP) contact and diabetes-related complications associated with PPH. Respondents experiencing PPH during the previous week reported measuring their BG 1.9 additional times on days they experienced symptoms of hyperglycemia vs. an average day. These results indicate PPH among adults with diabetes is common, and PPH is significantly associated with greater use of healthcare resources, including increased communication and contact with HCPs, greater incidence of diabetes-related complications and more frequent BG measurement. The additional use of healthcare resources associated with PPH may increase management costs for both T1D and T2D. Table 1 Self-reported HCP contact and medical complications related to diabetes by experience of PPH episodes PPH in No PPH in previous week previous week Diabetes-related calls or emails to physicians or other HCPs in the previous year (mean)*** Diabetes-related visits to physicians or other HCPs in the previous year (mean)*** Patients reporting ≥1 diabetes-related medical complication (%)*** High blood pressure (%)*** Eye problems (%)*** Neuropathy (%)*
2.7
1.4
5.5
4.4
72
55
41 33 28
29 21 21
Note: t-tests/Chi-square tests indicate significant differences by experienced PPH in previous week, *p<0.05, ***p<0.001. The associations between PPH and contact with HCPs were significant among those with T2D, but not T1D.
153 Achieving FPG Target Without Hypoglycemia: A Meta-Analysis of Insulin Degludec vs. Insulin Glargine U100 JINA HAHN*,†, LUIGI MENEGHINI†, STEPHEN ATKIN†, RAJEEV JAIN†, CHANTAL MATHIEU†, ATHENA PHILIS-TSIMIKAS†, LARS BARDTRUM†, DENIZ TUTKUNKARDAS†, BERNARD ZINMAN† Mississauga, ON
Insulin degludec (IDeg) is a basal insulin with a long and stable glucose-lowering effect and low day-to-day intra-patient variability compared with insulin glargine U100 (IGlar). This metaanalysis investigated the proportion of patients meeting the laboratory-measured FPG target of <130 mg/dL (7.2 mmol/L), which is the recommended pre-meal plasma glucose (PG) goal according to the 2015 ADA Standards of Medical Care in Diabetes, as well as the proportion doing so without experiencing nocturnal confirmed hypoglycemia. The patients who reached the FPG target were defined as those with an FPG level <130 mg/dL (7.2 mmol/L) at each visit during the maintenance period. Nocturnal-confirmed hypoglycemia was defined as any severe or confirmed (blood glucose <56 mg/dL [3.1 mmol/L]) self-monitored event occurring between 00:01 and 05:59, inclusive. The maintenance period is defined as all visits from week 16 onwards. Patients (type 1 diabetes [T1D] or type 2 diabetes [T2D]) from 7 open-label, randomized, treat-to-target trials treated with either IDeg (n=2501) or IGlar U100 (n=1256) were included. Use of IDeg resulted in significantly more patients reaching the FPG target at each visit throughout the maintenance period, as well as doing so without experiencing nocturnal confirmed hypoglycemia, compared with IGlar U100 (Figure). These results were similar across the 3 patient populations: T1D, T2D previously insulin treated and T2D insulin naïve. In conclusion, more patients treated with IDeg can achieve target FPG without experiencing nocturnal confirmed hypoglycemia compared with IGlar U100.
Abstracts / Can J Diabetes 40 (2016) S27–S74
With n=18, it correlated with the clamp increase in net Leu balance (r=0.555, p=0.017), signifying enhanced insulin-stimulated anabolism. Controlled for fasting insulin, this lost significance; hence, protein anabolism was mainly determined by insulin sensitivity. Results are consistent with adiponectin’s proposed role in: 1. regulating postabsorptive BCAAs, independent of associations with abdominal adiposity and insulin resistance, 2. suppressing BCAA catabolism. 152 Postprandial Hyperglycemia and Healthcare Resource Use KATHRYN M. PFEIFFER†, ANNIE NIKOLAJSEN†, JAMES WEATHERALL†, LARISA NURKANOVIC*,†, ARASH PAKSERESHT†, MERYL BROD† Mississauga, ON Postprandial hyperglycemia (PPH) among people with diabetes is a well-known challenge to diabetes management. While the impact of postprandial hypoglycemia on healthcare resource use has been well studied, little is known about the impact of PPH. This study aimed to assess the impact of respondent-reported PPH episodes on healthcare resource use among people with type 1 (T1D) or type 2 (T2D) diabetes using mealtime bolus insulin. Data were collected in an Internet survey of 906 adults with T1D (39%) or T2D (61%) treated with self-administered bolus insulin therapy, but not using pre-mixed insulin or GLP-1 analogues (with or without oral antidiabetic drugs), in Germany (34%), the UK (26%) and the USA (40%). Overall, 66% of respondents reported difficulty stabilizing postprandial blood glucose (BG) during the previous week, with 36% experiencing postprandial hypoglycemia and 62% experiencing PPH. Eleven per cent of respondents experienced postprandial hypoglycemia and 30% experienced PPH episodes ≥3 times in the previous week. Table 1 shows healthcare professional (HCP) contact and diabetes-related complications associated with PPH. Respondents experiencing PPH during the previous week reported measuring their BG 1.9 additional times on days they experienced symptoms of hyperglycemia vs. an average day. These results indicate PPH among adults with diabetes is common, and PPH is significantly associated with greater use of healthcare resources, including increased communication and contact with HCPs, greater incidence of diabetes-related complications and more frequent BG measurement. The additional use of healthcare resources associated with PPH may increase management costs for both T1D and T2D. Table 1 Self-reported HCP contact and medical complications related to diabetes by experience of PPH episodes PPH in No PPH in previous week previous week Diabetes-related calls or emails to physicians or other HCPs in the previous year (mean)*** Diabetes-related visits to physicians or other HCPs in the previous year (mean)*** Patients reporting ≥1 diabetes-related medical complication (%)*** High blood pressure (%)*** Eye problems (%)*** Neuropathy (%)*
2.7
1.4
5.5
4.4
72
55
41 33 28
29 21 21
Note: t-tests/Chi-square tests indicate significant differences by experienced PPH in previous week, *p<0.05, ***p<0.001. The associations between PPH and contact with HCPs were significant among those with T2D, but not T1D.
153 Achieving FPG Target Without Hypoglycemia: A Meta-Analysis of Insulin Degludec vs. Insulin Glargine U100 JINA HAHN*,†, LUIGI MENEGHINI†, STEPHEN ATKIN†, RAJEEV JAIN†, CHANTAL MATHIEU†, ATHENA PHILIS-TSIMIKAS†, LARS BARDTRUM†, DENIZ TUTKUNKARDAS†, BERNARD ZINMAN† Mississauga, ON
Insulin degludec (IDeg) is a basal insulin with a long and stable glucose-lowering effect and low day-to-day intra-patient variability compared with insulin glargine U100 (IGlar). This metaanalysis investigated the proportion of patients meeting the laboratory-measured FPG target of <130 mg/dL (7.2 mmol/L), which is the recommended pre-meal plasma glucose (PG) goal according to the 2015 ADA Standards of Medical Care in Diabetes, as well as the proportion doing so without experiencing nocturnal confirmed hypoglycemia. The patients who reached the FPG target were defined as those with an FPG level <130 mg/dL (7.2 mmol/L) at each visit during the maintenance period. Nocturnal-confirmed hypoglycemia was defined as any severe or confirmed (blood glucose <56 mg/dL [3.1 mmol/L]) self-monitored event occurring between 00:01 and 05:59, inclusive. The maintenance period is defined as all visits from week 16 onwards. Patients (type 1 diabetes [T1D] or type 2 diabetes [T2D]) from 7 open-label, randomized, treat-to-target trials treated with either IDeg (n=2501) or IGlar U100 (n=1256) were included. Use of IDeg resulted in significantly more patients reaching the FPG target at each visit throughout the maintenance period, as well as doing so without experiencing nocturnal confirmed hypoglycemia, compared with IGlar U100 (Figure). These results were similar across the 3 patient populations: T1D, T2D previously insulin treated and T2D insulin naïve. In conclusion, more patients treated with IDeg can achieve target FPG without experiencing nocturnal confirmed hypoglycemia compared with IGlar U100.