A 32-Week Randomized Comparison of Stepwise Insulin Intensification of Biphasic Insulin Aspart (BIAsp 30) Versus Basal-Bolus Therapy in Insulin-Naïve Patients with Type 2 Diabetes

Sultan Linjawi, Byung-Wan Lee, Ömür Tabak, Susanna Lövdahl, Shanti Werther, Salahedeen Abusnana, Sultan Linjawi, Byung-Wan Lee, Ömür Tabak, Susanna Lövdahl, Shanti Werther, Salahedeen Abusnana

Abstract

Introduction: This 32-week, open-label, randomized, parallel-group, multinational trial aimed to compare the efficacy and safety of stepwise insulin intensification of biphasic insulin aspart 30 (BIAsp 30) relative to stepwise intensification of a basal-bolus regimen in insulin-naïve adults with type 2 diabetes (T2D) who continued pretrial treatment with metformin and sulfonylurea.

Methods: Adults with T2D were randomized into one of two treatment arms for 32 weeks: (1) BIAsp 30 once daily (OD), with the possibility of stepwise treatment intensification up to BIAsp 30 three times daily (TID); (2) insulin glargine OD, with the possibility of stepwise treatment intensification with insulin aspart up to TID. The primary endpoint was change from baseline in HbA1c after 32 weeks.

Results: After 32 weeks, the estimated mean change in HbA1c from baseline was statistically significantly lower in the BIAsp 30 arm (- 1.18%) versus basal-bolus (- 1.36%) [estimated treatment difference 0.18%; 95% confidence interval (95% CI) 0.01; 0.36; p < 0.05]. The proportion of patients with HbA1c below 7.0% was statistically significantly lower with BIAsp 30 (42.9%) compared with basal-bolus (56.9%) (odds ratio 0.58; 95% CI 0.37; 0.89; p = 0.01). The overall rate of severe or blood glucose (BG)-confirmed hypoglycemic events was numerically lower for BIAsp 30 compared with basal-bolus, and a statistically significantly lower rate in nocturnal severe or BG-confirmed hypoglycemia in the BIAsp 30 arm relative to basal-bolus was observed: estimated rate ratio 0.32 (95% CI 0.13; 0.79), p = 0.0131. The proportion of patients with adverse events was similar in both treatment arms.

Conclusion: Insulin intensification with BIAsp 30 and basal-bolus showed an improvement in glycemic control; the change in HbA1c was statistically significantly lower for BIAsp 30 compared to basal-bolus. Basal-bolus treatment was accompanied by a numerically, and statistically significantly, higher rate of overall and nocturnal severe or BG-confirmed hypoglycemia, respectively, compared with BIAsp 30.

Funding: Novo Nordisk A/S.

Trial registration: ClinicalTrials.gov identifier, NCT02453685.

Keywords: BIAsp 30; Basal–bolus; Stepwise insulin intensification; Type 2 diabetes.

Figures

Fig. 1
Fig. 1
Mean HbA1c over time. BIAsp 30, biphasic insulin aspart 30
Fig. 2
Fig. 2
Observed mean HbA1c over time by treatment regimen. Full analysis set, observed data. BIAsp 30 biphasic insulin aspart 30, BID twice daily, IAsp insulin aspart, IGlar insulin glargine, OD once daily, TID three times a day
Fig. 3
Fig. 3
Severe or BG-confirmed treatment-emergent hypoglycemia cumulative plot. BIAsp 30, biphasic insulin aspart 30

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Source: PubMed

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