Health

Long-acting insulin found to be as effective as daily injections

March 11, 2011

Anne-Marie Tobin

THE CANADIAN PRESS

A modified insulin that gets absorbed very slowly after being injected once a day works as well as an existing form of insulin to control blood sugar, with lower rates of hypoglycemia, a study indicates.

Hypoglycemia occurs when blood sugar is too low, with symptoms ranging from cold sweats and headaches to convulsions and seizures.

And in a group of patients who received injections of the insulin degludec just three times a week — Mondays, Wednesdays and Fridays, with weekends off — glucose control and the proportion of participants with hypoglycemic episodes was the same as the group on the existing insulin, glargine.

“They used it three times a week, which is less inconvenient, and achieved the same results,” said Dr. Yogish Kudva, a consultant in endocrinology and internal medicine at Mayo Clinic College in Rochester, Minn.

The findings are promising, he said, adding that most patients with diabetes don’t want to have injections at all, if they can help it.

“Secondly, those who have to take them would prefer less, and thirdly, each additional injection per day is a burden for them,” he said.

Kudva was not connected to the study, but co-wrote a commentary about the Phase 2 trial results published this week in the medical journal The Lancet.

The Type 2 diabetes patients, aged 18 to 75, were taking oral antidiabetic drugs such as metformin when the trial began, but not insulin.

Of the 245 patients, 62 received degludec three times a week, while two groups of 60 and 61 patients got daily doses — each group receiving a different amount. A fourth group of 62 received glargine once a day.

Findings of the 16-week trial, which involved patients in Canada, India, South Africa and the United States, were reported by Dr. Bernard Zinman of the Samuel Lunenfeld Research Institute at Mount Sinai Hospital in Toronto and colleagues.

“It’s an exciting new insulin, it’s an ultra-long-acting insulin and the real issue is, of course, this is a small study, a proof-of-concept study, and we have to wait for the results of much larger studies to know where its place will be in a clinical setting,” Zinman said.

“It just has a much longer half-life, much more than 24 hours, compared to the other insulin and may provide some additional advantage.”

However, he said he doesn’t see that three-times-per-week injections will be a common way to treat diabetes.

“When you inject three times a week, the doses have to be increased so that it covers the full week, and in those circumstances, the benefits with respect to reducing the rates of hypoglycemia are not there,” he said.

“Personally, I wouldn’t use it that way. I would use it as once-daily insulin.”

But he thinks if people do forget to take their insulin on occasion, this would be more forgiving.

“We find people do occasionally forget their insulin, so this may — because it has a longer half-life and hangs around longer — that may be an advantage.”

“I think we need to do studies to really see if that’s the case.”

Zinman is not involved in Phase 3 trials of the drug, but said they are almost complete. The product would still require approval from regulatory authorities. Kudva noted the manufacturer is aiming for a marketing date of 2013.

As new drugs come on the scene, Kudva also emphasized the importance of health providers remembering to have the conversation with patients about healthy lifestyles — being more active and trying to eat well.

“So that’s a simple enough part of what all patients need to do, all citizens need to do — people with diabetes or not. And I think that cannot be emphasized enough.”

The study was sponsored by the drug maker Novo Nordisk of Denmark, and three of the paper’s authors are employees of the company and own stock. Zinman, who helped design the study and obtain and interpret the data, has received fees for consultancy and honoraria for membership of advisory boards from Novo Nordisk and a number of other drug companies.

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