1106-P: Predictive Modeling Suggests Subgroup Effects for Severe Hypoglycemia in T2DM Patients Treated with Gla-300 vs. IDeg: The LIGHTNING Study
Authors: HRAMIAK IRENE , HALUZIK MARTIN , WESTERBACKA JUKKA , BOSNYAK ZSOLT , ELIASSON BJORN , BLONDE LAWRENCE , BAILEY TIMOTHY S. 
Published: June 2019

The LIGHTNING study predictive modeling of U.S. health record data previously predicted similar severe hypoglycemia rates with insulin glargine 300 U/mL (Gla-300) and insulin degludec 100 U/mL (IDeg) in T2DM, using methodology including hypothesis-free generation of subgroups automatically derived from all available data using machine learning algorithms. This exploratory analysis examines those data-driven subgroups in which predicted severe hypoglycemia rates were lower with Gla-300 vs. IDeg.
The dataset used in LIGHTNING included 831,456 patients with T2DM using basal insulin (BI), and 198,198 patient-treatments (periods when patients used a BI) were eligible for hypoglycemia rate prediction. We present 10 subgroups showing the greatest absolute difference in predicted severe hypoglycemia rate in favor of Gla-300 vs. IDeg (Table). These subgroups frequently reflected cardiovascular (CV) disease, while other subgroups included acute kidney disease, thyroid disease, and neuromuscular block.
The novelty of the predictive modeling methodology used in LIGHTNING means that these data-driven subgroup findings are hypotheses-generating. Therefore, LIGHTNING indicates that further investigation into differences in severe hypoglycemia risk between Gla-300 and IDeg in possible high-risk subgroups (such as those with CV or renal disease) may be worthwhile.

Disclosure
I. Hramiak: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company, GlaxoSmithKline plc., Insulet Corporation, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Research Support; Self; AstraZeneca, Eli Lilly and Company, GlaxoSmithKline plc., Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; Merck & Co., Inc. M. Haluzik: None. J. Westerbacka: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. Z. Bosnyak: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. B. Eliasson: Advisory Panel; Self; Amgen Inc., AstraZeneca, Merck Sharp & Dohme Corp. Speaker's Bureau; Self; Boehringer Ingelheim International GmbH. Other Relationship; Self; Eli Lilly and Company, Novo Nordisk A/S, Sanofi. L. Blonde: Consultant; Self; Gilead Sciences, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi US. Research Support; Self; Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi US. Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi US. T.S. Bailey: Advisory Panel; Self; Abbott. Consultant; Self; Capillary Biomedical, Inc., Eli Lilly and Company, Medtronic, Novo Nordisk Inc., Sanofi. Research Support; Self; Abbott, Ascensia Diabetes Care, Becton, Dickinson and Company, Boehringer Ingelheim Pharmaceuticals, Inc., Calibra Medical, Capillary Biomedical, Inc., Companion Medical, Dance Biopharm Holdings Inc., Dexcom, Inc., Diasome Pharmaceuticals, Inc., Eli Lilly and Company, GlySens Incorporated, Kowa Pharmaceutical Europe Co. Ltd., Lexicon Pharmaceuticals, Inc., Medtronic, Novo Nordisk Inc., POPS! Diabetes Care, POPS! Diabetes Care, Sanofi, Senseonics, vTv Therapeutics, Xeris Pharmaceuticals, Inc., Zealand Pharma A/S. Speaker's Bureau; Self; Abbott, MannKind Corporation, Medtronic, Novo Nordisk Inc., Sanofi US, Senseonics.

Funding
Sanofi