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Title: The Safety and Efficacy of Second-Generation Basal Insulin Analogues in Adults with Type 2 Diabetes at Risk of Hypoglycemia and Use in Other Special Populations: A Narrative Review.
Austin Authors: Cheng, Alice Y Y;Wong, Jencia;Freemantle, Nick;Acharya, Shamasunder H;Ekinci, Elif I 
Affiliation: Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
Medicine (University of Melbourne)
Department of Diabetes, John Hunter Hospital, Hunter New England Health-University of Newcastle, New Lambton, NSW, Australia
Institute for Clinical Trials and Methodology, University College London, London, UK
Issue Date: Nov-2020
Date: 2020-09-25
Publication information: Diabetes Therapy 2020; 11(11): 2555-2593
Abstract: Hypoglycemia is a major barrier impeding glycemic control in persons with type 2 diabetes mellitus and creates a substantial burden on the healthcare system. Certain populations that require special attention, such as older adults and individuals with renal impairment, a longer duration of diabetes or those who have experienced prior hypoglycemia, may be at a higher risk of hypoglycemia, particularly with insulin treatment. Second-generation basal insulin analogues (insulin glargine 300 U/mL and degludec) have demonstrated reductions in hypoglycemia compared with insulin glargine 100 U/mL although evidence of this benefit across specific populations is less clear. In this review we summarize the literature with respect to the efficacy and safety data for second-generation basal insulin analogues in adults with type 2 diabetes mellitus who are at risk of hypoglycemia or who require special attention. Randomized controlled trials, meta-analyses and real-world evidence demonstrate that the use of second-generation basal insulin analogues is associated with less hypoglycemia compared with insulin glargine 100 U/mL without compromising glycated hemoglobin control. A reduced risk of hypoglycemia with second-generation basal insulin analogues was evident in older adults and in individuals with obesity, renal impairment, a history of cardiovascular disease or a long duration of insulin use. Further studies are needed in other populations, including those with more severe renal impairment or hepatic dysfunction, the hospitalized population and those with cognitive impairment. Overall, less hypoglycemia associated with second-generation basal insulin analogues may help reduce barriers for insulin use, improve adherence and offset the costs of hypoglycemia-related healthcare resource utilization.
DOI: 10.1007/s13300-020-00925-8
ORCID: 0000-0003-2729-606X
Journal: Diabetes Therapy
PubMed URL: 32975710
ISSN: 1869-6953
Type: Journal Article
Subjects: Basal insulin
Insulin glargine
Type 2 diabetes mellitus
Appears in Collections:Journal articles

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