Insulin Initiation with Insulin Degludec/Insulin Aspart versus Insulin Glargine in Oral Antidiabetic Drugs Failure Patients with Type 2 Diabetes Mellitus: A Real-World Study from India

Abstract

Oral antidiabetic drug (OAD) failure is an indication for starting insulin therapy, but
there is still a dilemma as to whether basal insulin or a premixed/co-formulation analog should
be the choice. Aim: To compare the safety and efficacy of once daily (OD) insulin degludec/
insulin aspart (IDegAsp) to OD insulin glargine (IGlar U100) in insulin-naïve Indian subjects
with type 2 diabetes mellitus (T2DM), inadequately controlled with OADs alone. Setting and
design: Retrospective study. Methods and material: Data was retrieved from the author’s
clinic database of OAD failure patients (18-80 years), who were started either with (IGlar U100,
n = 120) or IDegAsp (n = 89) OD over and above the standard of care. Data of fasting plasma
glucose (FPG), postprandial plasma glucose (PPG) and glycated hemoglobin (HbA1c) from
baseline and at last follow-up visits were collected. Statistical analysis used: Baseline
characteristics and change in study parameters during the follow-up period were computed
between two groups (IGlar U100 vs. IDegAsp) by unpaired t-test and paired t-test, respectively.
ANCOVA test was used to compute percentage reduction in body weight, body mass index
(BMI), FPG, PPG and HbA1c in between two groups (IGlar U100 vs. IDegAsp). Results:
IDegAsp caused a significantly greater reduction in FPG, PPG and HbA1c as compared to
the IGlar U100 arm. There was no significant difference in the proportion of patients with
hypoglycemia between IDegAsp and IGlar U100 groups (p = 0.208). No episodes of severe
hypoglycemia were reported. Conclusion: Comparison of IDegAsp and IGlar U100 OD in
T2DM patients indicated that both were relatively safe but the former controlled FPG and
PPG levels more effectively.