New-generation insulin to help achieve better control of diabetes
STARTING insulin treatment for type 2 diabetes is often thought of as a last resort. But according to Dr. Alice Yuk-Yan Cheng, associate professor of Endocrinology at the University of Toronto, instead of the standard route of using oral medication first, newly diagnosed patients may do better long term if they are started earlier on insulin treatment.
“Most people think of insulin as a difficult, painful, or potentially scary medical treatment. In fact, the idea of using insulin used to run counter to current guidelines that suggest meal planning, diet and exercise first, then oral medications to control blood sugar. Another fear is the complication of hypoglycemia or episodes of dangerously low blood sugar especially during that initial period when the doctor is still making adjust- ments as to how much dose the patient should be taking,” says Dr. Cheng.
Developing hypoglycemia poses an unaddressed threat to people with type 2 diabetes as such episodes can cause seizures, loss of consciousness and even death. Even the less severe symptoms like feeling shaky; sweating, chills and clamminess; feeling lighthead- ed or dizzy; fast heartbeat; and headaches are more than enough reasons for most patients to discontinue their insulin therapy and seek other means.
Moreover, older generation insulins were delivered only via vials and syringes with larger bore needles that caused a lot of pain.
Minimized
Such incidence may now be minimized with the emergence of second-generation, once daily, ultra-long-acting basal insulins like insulin glargine 300 units/mL (Glargine-300) and degludec 100 units/mL (Deg-100). Both agents provide comparable glycemic control to first-generation basal insulin and modes of action suited to once-daily regimens.
“These characteristics—second-generation insulins that employ pen devices that are easy to use, provide greater dose accuracy, and almost painless experience—may help overcome patient and doctor concerns about early insulin use in the management of type 2 diabetes,” believes Dr. Cheng who is a primary investigator of the BRIGHT study, a head-to-head clinical trial that compared Glargine-300 to Deg-100.
Dr. Cheng reports that Glargine-300 demonstrated comparable blood sugar (HbA1c) control versus Deg-100 (-1.64 percent vs -1.59 percent, respectively). “What’s more interesting is that during the first 12 weeks of therapy—a period when patients and doctors work to determine the most appropriate individual insulin dose—Glargine-300 significantly reduced the rate of confirmed anytime hypoglycemia events by 23 percent, and the incidence of low blood sugar events by 26 percent, compared to Deg-100.”
Results of the BRIGHT study, which followed 929 adults whose type 2 diabetes was previously uncontrolled on non-insulin medication, were presented at this year’s American Diabetes Association 78th Scientific Sessions held in Orlando, Florida.
Newer preparations
“With such newer insulin preparations and delivery devices available, more patients should find insulin treatment acceptable,” adds Dr. Cheng.
She adds that the BRIGHT study results show positive data that could lead to a better understanding of optimal treatment for the more than 5 million Filipinos living with diabetes. “This is not the first time Glargine-300 is compared to other insulins, and consistently showed positive results—confirming that Glargine-300 has the potential to help people with diabetes reach their targets with lower risk of hypoglycemia.”
It should be noted that around 50,000 diabetic Filipinos die each year due to diabetes-related complications like heart attack, stroke, and kidney and heart failure.
If nothing is done, the prevalence of diabetes is expected to soar by 20 percent by the year 2045, resulting to more than 100,000 Filipinos dying every year due to complications.