JDM  Vol.3 No.4 , November 2013
Compared with insulin glargine, insulin degludec narrows the day-to-day variability in the glucose-lowering effect rather than lowering blood glucose levels
Abstract: Background: Changes in the day-to-day variability in the glucose-lowering effect of insulin [fluctuations of blood glucose levels (BG) seen during the same time period] that occur when insulin glargine (glargine) is replaced with insulin degludec (degludec) have not been sufficiently evaluated. Subjects: Five diabetics with unstable BG undergoing basal-bolus treatment using insulin glargine as basal insulin. Methods: Basal insulin was changed from glargine to same-dose degludec. The subjects’ HbA1c, glycoalbumin, and 1.5-anhydro-D-glucitol were measured before and after the switchover. Fasting blood glucose concentration (FBG) and predinner blood glucose concentration (PDBG) were measured continuously for 28 days immediately before the switchover, and 28 days immediately thereafter, to compare and evaluate 1) the changes in their mean values and standard deviations (SDs) before and after the switchover, and 2) the frequency of appearance of BG of over 180 mg/dL (BG ≥ 180) and under 70 mg/dL (BG < 70), among other items. Bolus insulin remained completely unchanged. Results: The levels of HbA1c, glycoalbumin, FBG’s mean value, SDs, BG ≥ 180 and BG < 70 all decreased. On the other hand, although PDBG’s SD as well as BG ≥ 180 and BG < 70 decreased, PDBG’s but not FBG’s mean values remained unchanged. The levels of 1.5-anhydro-D-glucitol rose. The mean values of BG ≥ 180 decreased in all subjects. Conclusion: The possibility was shown that degludec, to a greater extent than glargine, suppressed daily fluctuations of FBG and PDBG, suppressed the occurrence frequency of hyperglycemia and hypoglycemia, and exerted more steady hypoglycemic actions.
Cite this paper: Ogawa, S. , Nako, K. , Okamura, M. , Senda, M. , Sakamoto, T. and Ito, S. (2013) Compared with insulin glargine, insulin degludec narrows the day-to-day variability in the glucose-lowering effect rather than lowering blood glucose levels. Journal of Diabetes Mellitus, 3, 244-251. doi: 10.4236/jdm.2013.34037.

[1]   Holman, R.R., Paul, S.K., Bethel, M.A., Matthews, D.R. and Neil, H.A. (2008) 10-year follow-up of intensive glucose control in type 2 diabetes. New England Journal of Medicine, 359, 1577-1589.

[2]   Nathan, D.M., Cleary, P.A., Backlund, J.Y., Genuth, S.M., Lachin, J.M., Orchard, T.J., Raskin, P., Zinman, B., Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group (2005) Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. New England Journal of Medicine, 353, 2643-2653.

[3]   NICE-SUGAR Study Investigators, Finfer, S., Liu, B., Chittock, D.R., Norton, R., Myburgh, J.A., McArthur, C., Mitchell, I., Foster, D., Dhingra, V., Henderson, W.R., Ronco, J.J., Bellomo, R., Cook, D., McDonald, E., Dodek, P., Hébert, P.C., Heyland, D.K. and Robinson, B.G. (2012) Hypoglycemia and risk of death in critically ill patients. New England Journal of Medicine, 367, 1108-1118. 10.1056/NEJMoa1204942

[4]   Heise, T., Nosek, L., Ronn, B.B., Endahl, L., Heinemann, L., Kapitza, C. and Draeger, E. (2004) Lower within-subject variability of insulin detemir in comparison to NPH insulin and insulin glargine in people with type 1 diabetes. Diabetes, 53, 1614-1620.

[5]   Heise, T., Nosek, L., Bottcher, S.G., Hastrup, H. and Haahr, H. (2012) Ultra-long-acting insulin degludec has a flat and stable glucose-lowering effect in type 2 diabetes. Diabetes, Obesity and Metabolism, 14, 944-950.

[6]   Heise, T., Hermanski, L., Nosek, L., Feldman, A., Rasmussen, S. and Haahr, H. (2012) Insulin degludec: Four times lower pharmacodynamic variability than insulin glargine under steady-state conditions in type 1 diabetes. Diabetes, Obesity and Metabolism, 14, 859-864. 10.1111/j.1463-1326.2012.01627.x

[7]   Moghissi, E.S., Korytkowski, M.T., DiNardo, M., Einhorn, D., Hellman, R., Hirsch, I.B., Inzucchi, S.E., Ismail-Beigi, F., Kirkman, M.S. and Umpierrez, G.E. American Association of Clinical Endocrinologists; American Diabetes Association (2009) American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care, 32, 1119-1131.

[8]   Seaquist, E.R., Anderson, J., Childs, B., Cryer, P., Dagogo-Jack, S., Fish, L., Heller, S.R., Rodriguez, H., Rosenzweig, J. and Vigersky, R. (2013) Hypoglycemia and diabetes: A report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care, 36, 1384-1395.