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Hypoglycaemia, irrespective of the definition used, is reduced when switching to insulin degludec from other basal insulins in routine clinical care: The ReFLeCT study
Beta Cell Diabetes Centre, Chelsea and Westminster Hospital, London, UK; University of Surrey, Guildford, UK.
Department of Medicine, Division of Metabolic Diseases, University of Padova, Padova, Italy.
Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
Örebro University, School of Medical Sciences.ORCID iD: 0000-0003-1025-1682
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2019 (English)Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Background and aims: ReFLeCT was a multicentre, prospective, observational study designed to investigate the safety and effectiveness of switching to insulin degludec (degludec) from other basal insulins in patients with type 1 (T1D) or type 2 diabetes (T2D). Few studies had prospectively collected hypoglycaemia data from patient diaries following a switch to degludec in everyday clinical practice. These additional analyses from the ReFLeCT study aimed to assess the effects of switching to degludec according to different hypoglycaemia definitions.

Materials and methods: ReFLeCT comprised a 4-week baseline period (pre-switch basal insulin) and a 12-month follow-up period (degludec treatment). The primary endpoint of overall hypoglycaemia reported in patient diaries was reduced during follow-up vs baseline in T1D and T2D with improvement of glycaemic control, as previously reported. Here, hypoglycaemia data from ReFLeCT were analysed using pre-specified and updated (post hoc) American Diabetes Association (ADA) hypoglycaemia definitions. Definitions consisted of: documented asymptomatic and symptomatic, pseudo, probable symptomatic, and Level 1, 2 and 3 (severe) hypoglycaemia (Fig). Hypoglycaemic events were analysed using fully adjusted, negative binomial regression models.

Results: In T1D (n=556) and T2D (n=611), estimated rate ratios across the previous and the updated ADA hypoglycaemia definitions were significantly lower during the 12-month follow-up vs the baseline period, except for asymptomatic hypoglycaemia in T1D and Level 3 hypoglycaemia in T2D (due to a low number of severe hypoglycaemic events, no comparable statistics were performed) (Fig). Event rates per patient year were also lower for all definitions during the 12-month follow-up vs the baseline period, except for Level 3 hypoglycaemia in T2D, which marginally increased, although this was likely due to the low number of events in this group.

Conclusion: In patients with T1D and T2D, switching to degludec from other basal insulins in routine clinical care is associated with lower rates of hypoglycaemia across a broad range of hypoglycaemia definitions, in combination with improved glycaemic control.

Place, publisher, year, edition, pages
Springer, 2019. Vol. 2, p. S385-S385
Series
Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:oru:diva-76878ISI: 000485303803121OAI: oai:DiVA.org:oru-76878DiVA, id: diva2:1356230
Conference
55th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD 2019), Barcelona, Spain, September 16-20, 2019
Available from: 2019-10-01 Created: 2019-10-01 Last updated: 2019-10-15Bibliographically approved

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Jendle, Johan

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