Efficacy and safety of degludec insulin: a meta-analysis of randomised trials

Abstract

Objectives:

Degludec is a novel long-acting insulin analogue, providing an adequate supply of basal insulin over 24 hours with one daily injection, with a supposed greater reproducibility and flexibility than other basal insulins.

Methods:

An extensive search of Medline and the Cochrane Library for ‘degludec’ was performed, up to July 1st, 2012, collecting all randomised trials with a duration of at least 16 weeks and enrolling patients with diabetes. The principal outcome was the effect of degludec, compared with other basal insulins, on endpoint HbA1c and hypoglycaemia. Secondary outcomes included BMI, FPG at endpoint, and the incidence of cardiovascular events and cancer.

Results:

In the four trials comparing degludec with glargine, endpoint HbA1c was similar in the two groups, whereas FPG was significantly lower in degludec-treated patients. Degludec was associated with a lower rate of overall and nocturnal hypoglycaemia in type 2 and type 1 diabetes, respectively. No differences were observed for cardiovascular events and cancer.

Study limitations:

The number of available trials and the duration of exposure were limited, so the results obtained should be considered preliminary.

Conclusions:

Degludec appears to be associated with a lower incidence of hypoglycaemia in comparison with glargine, for similar levels of glycaemic control. The use of this agent could represent one step further in insulin therapy.

Key words::

• Degludec
• Diabetes mellitus
• Efficacy
• Insulin
• Meta-analysis
• Safety

Transparency

Declaration of funding

This study was not funded.

M.M. was involved in each of the following points: design; data collection; analysis; writing manuscript. E.M. was involved in each of the following points: design; data collection; analysis; writing manuscript. Both the authors approved the final version of this manuscript.

Declaration of financial/other relationships

M.M. has received speaking fees from Bristol Myers Squibb, Merck, and Takeda, and research grants from Astra Zeneca. E.M. has received consultancy fees from Merck and Novartis, speaking fees from Astra Zeneca, Bristol Myers Squibb, Merck, and Novartis, and research grants from Merck, Novartis, and Takeda.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.