All-cause mortality risk nearly halved with insulin degludec vs. glargine
Adults with diabetes may have lower all-cause mortality risk if they use insulin degludec instead of insulin glargine U100, according to findings published in Diabetes/Metabolism Research and Reviews.
“Evidence of the safety of insulin degludec vs. glargine U100 is rich with respect to controlled settings and sometimes unnatural population selections in randomized controlled trials,” Morten Hasselstrøm Jensen, MSc, PhD, an assistant professor in the department of health science and technology and the faculty of medicine at Aalborg University and Aalborg University Hospital in Aalborg, Denmark, and colleagues wrote. “On the other hand, real-world evidence of the safety is sparse.”
Jensen and colleagues used the Danish National Patient Registry, the National Pharmacological Database of the Danish Medicines Agency and the Danish Register of Causes of Death to identify adults with diabetes in Denmark prescribed insulin and the outcomes, such as major adverse cardiovascular events, severe hypoglycemia and all-cause mortality, from 2016 to 2017 in these patients.
The researchers identified insulin degludec (Tresiba, Novo Nordisk) use among 5,159 adults (mean age, 66 years; 39.6% women) and insulin glargine U100 (Lantus, Sanofi) use among 4,041 adults (mean age, 65 years; 40% women). Adults who used insulin degludec had a mean diabetes duration of 13 years vs. 10 years for those who used insulin glargine U100 (P < .0001).
“One explanation [for the longer diabetes duration among insulin degludec users] could be a better mortality benefit ... for degludec as compared with glargine,” the researchers wrote. “Another explanation could be that an indication for switching to degludec is issues with hypoglycemia, and risk of severe hypoglycemia increases with diabetes duration, which could explain the higher diabetes duration among degludec users. Another observation is the higher insulin dose among degludec users.”
Adults who used insulin delgudec were at lower all-cause mortality risk than those who used insulin glargine U100 in fully adjusted models (HR = 0.54; 95% CI, 0.44-0.65). There were 22 deaths related to malignant neoplasm of the pancreas among adults who used insulin glargine U100 vs. seven among those who used insulin degludec.
“A statistically significant approximately twofold reduced risk of death was found for degludec compared with glargine U100, which suggest that degludec has a safer profile than glargine with respect to all-cause mortality,” the researchers wrote. “These results add to the evidence that degludec has a safer profile, which should be considered when choosing treatment in clinical practice.” – by Phil Neuffer
Disclosures: Jensen reports he is a former employee and current shareholder of Novo Nordisk. Please see the study for all other authors’ relevant financial disclosures.