Insulin degludec/aspart trumps basal insulin in diabetics with low FPG

In diabetes patients with low fasting plasma glucose (FPG), once-daily insulin degludec/aspart (IDeg/Asp) seems to be a better treatment option than basal insulin, a new study has found.

Researchers conducted a retrospective observational study of 87 patients given IDeg/Asp and 87 propensity-matched controls given basal insulin. The primary outcomes were change in glycated haemoglobin (HbA1c) over 6 months and associated clinical factors.

At baseline, HbA1c was comparable between groups (8.7±0.9 percent vs 8.6±0.9 percent). After 6 months of intervention, IDeg/Asp participants had significantly lower HbA1c levels than controls (8.1±1.0 percent vs 8.4±1.1 percent; p=0.029).

At baseline, despite matching, IDeg/Asp patients had a significantly lower FPG than controls (124.2±38.4 vs 148.0±50.6 mg/dL; p<0.001), which remained true until 6 months (121.1±37.8 vs 141.1±42.1 mg/dL; p=0.001).

To investigate the effect of FPG on the efficacy of IDeg/Asp, researchers conducted a subgroup analysis according to the ratio of FPG to the estimated average glucose (eAG) value, a parameter calculated from HbA1c.

In participants with FPG/eAG value <0.6, IDeg/Asp led to a significant 6-month drop in HbA1c (8.7±0.8 percent to 8.2±1.0 percent; p<0.001), whereas controls saw no such change (8.7±0.9 percent to 8.5±1.2 percent; p=0.495). The difference in effect between both arms in this subgroup was statistically significant (p=0.043). Notably, no such effect was reported for participants with FPG/eAG values ≥0.6.

“We observed that once-daily IDegAsp was more effective in HbA1c reduction than basal insulin, especially in patients with lower FPG relative to concurrent HbA1c level. This seemed to indicate marked postprandial hyperglycaemia. Insulin deficiency might contribute to these phenomena,” researchers said.