Efficacy and Safety of IDegAsp Versus BIAsp 30, Both Twice Daily, in Elderly Patients with Type 2 Diabetes: Post Hoc Analysis of Two Phase 3 Randomized Controlled BOOST Trials

Greg Fulcher, Roopa Mehta, Edmond G Fita, Magnus Ekelund, Stephen C Bain, Greg Fulcher, Roopa Mehta, Edmond G Fita, Magnus Ekelund, Stephen C Bain

Abstract

Introduction: The majority of elderly patients (≥ 65 years of age) with type 2 diabetes mellitus (T2DM) will eventually require insulin therapy, but they are particularly vulnerable to hypoglycemia and challenging to treat. Insulin degludec/insulin aspart (IDegAsp) is a novel co-formulation of 70% insulin degludec and 30% insulin aspart administered in a single injection, either once or twice daily with main meals.

Methods: A combined analysis of the phase 3 BOOST INTENSIFY PREMIX I (NCT01009580) and BOOST INTENSIFY ALL (NCT01059812) trials has previously reported lower rates of hypoglycemia during the maintenance period in patients with T2DM treated with IDegAsp twice daily (BID) versus biphasic insulin aspart 30 (BIAsp 30) BID. This post hoc analysis examined the safety and efficacy of IDegAsp versus BIAsp 30 in elderly patients from the global population of these two trials, and also from the Japanese cohort of BOOST INTENSIFY ALL.

Results: Change in HbA1c was similar for IDegAsp versus BIAsp 30 (p > 0.5). Compared with BIAsp 30, IDegAsp resulted in significant reductions in fasting plasma glucose (p < 0.0001), numerically lower rates of overall and nocturnal hypoglycemia (global estimated rate ratios: 0.92 [0.67; 1.26]95% confidence interval [CI], p = 0.5980 and 0.67 [0.39; 1.18]95% CI, p = 0.1676, respectively), and a significantly lower total daily insulin dose at end of trial (global estimated treatment difference 0.79 [0.73; 0.87]95% CI, p < 0.0001) in elderly patients.

Conclusion: The results described here are consistent with those of the overall trial populations, demonstrating that IDegAsp BID is efficacious in elderly patients and suggesting that there is no need for special safety precautions.

Funding: Novo Nordisk.

Trial registration: ClinicalTrials.gov identifiers, NCT01009580 and NCT01059812. Plain language summary available for this article.

Keywords: Elderly; Insulin degludec/insulin aspart; Type 2 diabetes.

Figures

Fig. 1a–b
Fig. 1a–b
Trial designs for a BOOST INTENSIFY PREMIX I (global patient population) [31] and b BOOST INTENSIFY ALL (pan-Asian patient population) [32]. BIAsp 30 biphasic insulin aspart 30, BID twice daily, BMI body mass index, DPP-4i dipeptidyl peptidase-4 inhibitor, HbA1c glycated hemoglobin, IDegAsp insulin degludec/insulin aspart, met metformin, n number randomized, OAD oral antidiabetic drug, OD once daily, pio pioglitazone
Fig. 2
Fig. 2
Estimated rate ratios for overall confirmed and nocturnal confirmed hypoglycemia. BIAsp 30 biphasic insulin aspart 30, CI confidence interval, IDegAsp insulin degludec/insulin aspart

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