Clinical Evidence of Insulin Degludec in Type 2 Diabetes

Mark Warren, MD: In the SWITCH 1 and SWITCH 2 trials, glargine and degludec were compared in a crossover fashion. The SWITCH 1 trial involved patients with type 1 diabetes; SWITCH 2 involved patients with type 2. And all these patients were patients who were high risk for hypoglycemia. So, we enriched the trial with patients who were at higher risk for hypoglycemia, and the goal was to see if there’s any differences in hypoglycemia between degludec and U100 glargine insulin. What we found was a very consistent reduction in hypoglycemia with degludec compared with U100 glargine, anywhere from 30% to 50%. There was 40% less nocturnal hypoglycemia and 50% less severe hypoglycemia, which goes along with what we thought would happen since these insulins have less variability in their absorption from day to day.

The clinical trials ultimately showed us that degludec gives a significant reduction in hypoglycemia, clinically significant as well as statistically significant. They’re extremely important when we treat diabetes, and these are patients who, again, had a higher risk of hypoglycemia. Just the reduction in nocturnal hypoglycemia is very important, because patients really have a phobia of nocturnal hypoglycemia, because they’re not alert and awake and they’re afraid of having a severe episode of hypoglycemia at night. So, they tend to preempt that by eating more, taking less insulin, etc. These are very important findings in the SWITCH 1 and SWITCH 2 studies.