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New ultra-long-acting insulin improves glucose control even when injected just three times a week instead of daily

A study assessing a new longer-acting form of insulin—degludec— has shown that when given once daily it is as effective at controlling blood sugar as existing insulin glargine injections but with lower rates of hypoglycaemia. Consistent with its long acting properties the study also demonstrated that  patients could achieve the same level of glucose control when the insulin was  administered just three times a week instead of daily. The Article, published Online First and in this week’s Lancet, is written by Professor Bernard Zinman, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, ON, Canada, and colleagues.

Insulin degludec is a unique type of injectable insulin  currently in development. In this 16-week, randomized phase 2 proof of concept  trial , participants aged 18–75 years with type 2 diabetes and glycosylated haemoglobin (HbA1C) of 7•0–11•0% were enrolled and treated at 28 clinical sites in Canada, India, South Africa, and the USA. A value of 7.0% or under is usually the target for diabetes patients. Patients were randomly allocated to receive insulin degludec once daily, insulin degludec  three times weekly or insulin glargine once daily.   At study end, mean HbA1C levels were much the same across treatment groups ranging from 7.2% to 7.5%. Fewer participants suffered hypoglycaemia (abnormally low blood sugar) in the insulin degludec once daily compared to the other  groups and the number of adverse events was much the same across groups, with no apparent treatment-specific pattern.

Professor Zinman* says: “Because of its ultra-long action profile, insulin degludec injected three times weekly appears to provide similar glucose control to insulin glargine once daily. This new basal insulin analogue might be a valuable addition to clinical practice…However the safety, efficacy, and optimum use of treatment regimens for insulin degludec will need to be established in larger phase 3 trials.”

In a linked Comment, Dr Yogish C Kudva and Dr Ananda Basu, Mayo Clinic College of Medicine, Rochester, MN, USA, say: “Doses  given three times a week might improve adherence, improve glycaemic control without an increase in hypoglycaemia, and cause less disruption to the patient’s lifestyle.” They add that lifestyle changes (diet and exercise) are inexpensive and favourable to patients, yet need constant re-emphasis, even as the numbers of long-acting drugs for type 2 diabetes increases.

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