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Combination basal–bolus therapy reduces HbA1c, total insulin dose in type 1 diabetes
Adults with type 1 diabetes randomly assigned a regimen of combined insulin degludec/insulin aspart for 52 weeks saw improved glycemic control, long-term reductions in HbA1c and a lower total daily insulin dose with fewer injections vs. adults assigned a typical basal–bolus regimen with separate injections, study findings show.
“The ability to provide glycemic control over 52 weeks with one less injection compared with a conventional basal–bolus insulin regimen could be of real value to participants by alleviating the injection burden, and thereby potentially improving adherence and quality of life,” Irl B. Hirsch, MD, professor of medicine at the University of Washington in Seattle, and colleagues wrote.
Irl B. Hirsch
Researchers analyzed trial extension data from BOOST T1, a 52-week study including a core and extension phase, each 26 weeks long. Researchers randomly assigned adults with type 1 diabetes 2:1 to insulin degludec/aspart once daily (at main meal) with additional insulin aspart at remaining meals (n = 233) or insulin detemir once daily (at evening meal) with insulin aspart at mealtimes (n = 122). Dosing of insulin degludec/aspart could be administered during any main meal according to participant and physician preference. Primary endpoints included adverse events, hypoglycemia, insulin dose and body weight.
After 52 weeks, participants assigned insulin degludec/aspart therapy experienced fewer incidents of confirmed hypoglycemia than those assigned insulin detemir (31.8 vs. 36.7 episodes/patient years of exposure); the rate of nocturnal confirmed hypoglycemia also was lower in the insulin degludec/aspart group (3.1 vs. 5.4 episodes/patient years of exposure). Adverse event rates were comparable between groups.
Mean HbA1c fell by 0.7% in the insulin degludec/aspart group to 7.6% at 52 weeks vs. a mean decrease of 0.6% in the insulin detemir group (mean HbA1c at week 52, 7.7%). Mean total daily insulin dose was lower with insulin degludec/aspart than insulin detemir therapy (mean dose ratio in units: 0.87; 95% CI, 0.79-0.95), indicating that the mean total daily insulin dose at the end of the extension phase was 13% lower with insulin degludec/aspart therapy than with traditional basal-bolus therapy, according to researchers.
“Notably, pre-meal glucose levels at all three main meals were lower with [insulin degludec/aspart], which indicates the longer-acting nature of [insulin degludec] compared with current basal insulin analogues,” the researchers wrote. – by Regina Schaffer
Disclosure: This study was funded by Novo Nordisk A/S, Denmark. Hirsch reports receiving research support from Novo Nordisk and Sanofi-USA, and serving as a consultant for Abbott Diabetes Care, Roche and Valeritas. Please see the full study for the other authors’ relevant financial disclosures.