Real-World Clinical Outcomes of Type 2 Diabetes (T2D) Patients Switching from Insulin Glargine 100 U/mL (Gla-100) or Insulin Detemir (IDet) to Insulin Glargine 300 U/mL (Gla-300) or Insulin Degludec (IDeg)—DELIVER D+
Authors: SULLIVAN SEAN D. , BAILEY TIMOTHY S. , ROUSSEL RONAN , ZHOU FANG L. , BOSNYAK ZSOLT , PREBLICK RON , WESTERBACKA JUKKA , GUPTA RISHAB , BLONDE LAWRENCE 
Published: June 2018

This retrospective, observational study compared clinical outcomes of adults with T2D switching from Gla-100/IDet to Gla-300 or IDeg. Electronic medical records (Predictive Health Intelligence Environment database) (3/1/15-1/31/17) were analyzed. Switchers with ≥1 A1C during 6—month baseline were propensity score matched on baseline demographic and clinical characteristics (including percentage of patients originally on Gla-100/IDet). Endpoints were A1C change and goal attainment in those with ≥1 A1C test during 3-6-month follow-up, and hypoglycemia (hypo) in all 3184 matched patients. Hypo (ICD-9/ 10 and/or plasma-glucose level ≤70 mg/dL overall, or associated with an inpatient/ED encounter) was assessed using fixed follow-up (intent-to-treat [ITT], full 6 months) and variable follow-up (on treatment [OT], till discontinuation or 6 months). A1C reduction was comparable between Gla-300 (n=742) and IDeg (n=727) switchers (0.63% and 0.58%, respectively, p=0.49). A1C &lt;7% was attained in 15.1%/16.1% among Gla-300/IDeg switchers, respectively (p=0.63); &lt;8% in 44.3%/44.4%, respectively (p=0.98). By ITT, switching to Gla-300 (n=1592) reduced hypo incidence (all: 15.6% to 12.7%; p=0.01; inpatient/ED: 5.3% to 3.5%; p=0.01); switching to IDeg (n=1592) resulted in non-significant reductions (all: 14.3% to 12.7%; p=0.12; inpatient/ED: 4.1% to 3.6%; p=0.40). After adjusting baseline hypo incidence, no significant differences were found in follow-up between the two groups. By OT, hypo incidence was similar in both groups (adjusted hazard ratio: 1.02; p=0.88), but Gla-300 switchers had lower inpatient/ED hypo event rates in follow-up (adjusted rate ratio: 0.56; p=0.02). In a real-world setting of adults with T2D, switching from Gla-100/IDet to Gla—300 or IDeg resulted in comparable improvements in glycemic control and comparable/better hypo outcomes.

Disclosure

S.D. Sullivan: None. T.S. Bailey: Research Support; Self; Abbott. Consultant; Self; Abbott. Speaker's Bureau; Self; Abbott. Research Support; Self; Ambra BioScience, Ascensia Diabetes Care, Becton, Dickinson and Company. Consultant; Self; Becton, Dickinson and Company. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Calibra Medical. Consultant; Self; Calibra Medical. Research Support; Self; Companion Medical, Dexcom, Inc., Glooko, Inc., GlySens Incorporated, Lexicon Pharmaceuticals, Inc., Eli Lilly and Company. Consultant; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company. Research Support; Self; Medtronic MiniMed, Inc.. Consultant; Self; Medtronic MiniMed, Inc.. Speaker's Bureau; Self; Medtronic MiniMed, Inc.. Research Support; Self; Novo Nordisk Inc.. Consultant; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Novo Nordisk Inc.. Research Support; Self; Sanofi. Consultant; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; Senseonics. Consultant; Self; Intarcia Therapeutics, Inc.. Research Support; Self; Versartis, Inc., Xeris Pharmaceuticals, Inc., MannKind Corporation. R. Roussel: Advisory Panel; Self; AbbVie Inc., Abbott, Eli Lilly and Company, Sanofi, Novo Nordisk A/S, AstraZeneca. Speaker's Bureau; Self; Servier. Consultant; Self; Bayer AG. Advisory Panel; Self; Merck Sharp & Dohme Corp.. Research Support; Self; Amgen Inc., Sanofi, Novo Nordisk A/S, Danone Research. Stock/Shareholder; Self; Iriade. Advisory Panel; Self; Physiogenex S.A.S. F.L. Zhou: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. Employee; Spouse/Partner; Lexicon Pharmaceuticals, Inc.. Stock/Shareholder; Spouse/Partner; Lexicon Pharmaceuticals, Inc. Z. Bosnyak: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. R. Preblick: Employee; Self; Sanofi. J. Westerbacka: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. R. Gupta: Other Relationship; Self; Sanofi. L. Blonde: Other Relationship; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca. Advisory Panel; Self; Intarcia Therapeutics, Inc.. Other Relationship; Self; Lexicon Pharmaceuticals, Inc.. Advisory Panel; Self; Janssen Pharmaceuticals, Inc.. Other Relationship; Self; Janssen Scientific Affairs, LLC.. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc.. Advisory Panel; Self; Merck & Co., Inc., Novo Nordisk Inc.. Speaker's Bureau; Self; Novo Nordisk Inc.. Other Relationship; Self; Novo Nordisk Inc., Sanofi. Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Sanofi US.