733-P: A Randomized Controlled Trial Comparing Insulin Degludec U100 and Glargine U100 for the Inpatient Management of Medicine and Surgery Patients with Type 2 Diabetes: Degludec Hospital Trial

Abstract

Limited data exist about the use of insulin degludec in the hospital. This prospective, open-label, randomized clinical trial compared the efficacy and safety of a basal-bolus regimen using degludec U100 or glargine U100 for the management of patients with T2D. A total of 181 general medicine and surgery patients (age: 56±11, diabetes duration: 13.0±9.2 years) with an admission BG: 140-400 mg/dL and treated with oral agents or insulin prior to admission were randomized to degludec (n=93) or glargine (n=88). Total daily insulin dose started at 0.4 U/kg/d for BG: 140-200 mg/dL or 0.5 U/kg/d for BG: 201-400 mg/dL half dose given as basal (degludec or glargine) once daily and half as prandial (aspart) before meals. Insulin was adjusted daily to a target BG before meals between 70-180 mg/dL. The primary outcome was a difference in mean daily BG during the hospital stay. For the entire cohort, the BG at randomization was 218.6±52 mg/dL and HbA1c: 9.79±2.0% [mean±SD]. There were no differences in mean daily BG (180.1±38 vs. 180.0±45 mg/dL, p=0.9), proportion of BG in target range of 70-180 mg/dL (54.5±29% vs. 55.3±28%, p=0.85), total daily insulin dose (56±24 vs. 59±36 units/day, p=0.92), basal insulin (29.6±13 vs. 30.4±18 units/day, p=0.85), length of stay (median (IQR): 6.7 (4.7-10.5) vs. 7.5 (4.7,11.6) days, p=0.61), hospital complications (23% vs. 23%, p=0.95), or treatment failures ([mean daily BG>240 mg/dL or >2 consecutive BG>240 mg/dL] 9.8% vs. 13%, p=0.62) between degludec and glargine. There were no differences in the proportion of patients with BG <70 mg/dL (17% vs. 19%, p=0.75) or <54 mg/dL (3.7% vs. 1.3%, p=0.62) between degludec and glargine, with no patients having a BG<40mg/dL. In summary, our study indicates that hospital treatment with degludec U100 or glargine U100 is equally effective and safe in improving glycemic control in general medicine and surgery patients with T2D. Disclosure R. J. Galindo: Consultant; Self; Abbott Diabetes, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk, Sanofi US, Valeritas, Inc., Research Support; Self; Dexcom, Inc., Novo Nordisk. S. Cardona: None. K. W. Zamudio: None. B. S. Albury: None. M. C. Perez-guzman: None. L. Peng: None. G. E. Umpierrez: Research Support; Self; AstraZeneca, Dexcom, Inc., Novo Nordisk. F. J. Pasquel: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Research Support; Self; Dexcom, Inc., Merck & Co., Inc. P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. R. Z. Alicic: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc. D. W. Lam: None. M. Fayfman: None. A. Migdal: None. M. A. Urrutia: None. G. Davis: None. Funding Novo Nordisk