The comparative analysis of efficacy and safety parameters of Insulin Degludec versus Insulin Glargine: A Narrative Review

Abstract

Background and aim: Insulin degludec and insuline glargine are the two long-acting insulins most commonly prescribed for the treatment of Diabetes Type 1 as well as Diabetes Type 2. Both insulins were generated to address a clinical need for the basal insulin which produces a more even and flat activity profile and reduces the number of hypoglycemia- a dangerous side effect of insulin therapy. Although glargine and degludec confirmed their superiority in terms of reduced rate of hypoglycemia, especially in comparison with first generations, several studies revealed that degludec is associated with less glycemic variability. Moreover, degludec is more effective in reaching better fasting plasma glucose levels without increasing a risk of nocturnal hypoglycemia. The aim of this study is to compare the five most essential efficacy and safety parameters of insulin degludec versus insulin glargine. Methods: This study used a narrative synthesis of the research findings. The search for existing narrative and systematic reviews on the research topic was conducted through PubMed, Embase, and Google Scholar electronic databases. Reviews were selected according to a study design and methodological quality of the included studies. The reviews published within 2015-2023 period were included. The data on five safety and efficacy parameters (the reduction of fasting plasma glucose level, HbA1c levels, overall and nocturnal hypoglycemia episodes, body weight gain) were retrieved for the analysis. Findings: The analysis of data retrieved out of 10 systematic reviews confirmed superiority of insulin degludec in comparison with insulin glargine in terms of four safety and efficacy parameters. The treatment with degludec was associated with fewer overall and nocturnal hypoglycemia episodes, a better reduction of fasting plasma glucose levels in both Diabetes Type 1 and Diabetes Type 2 groups (insulin naïve and experienced) patients, less weight gain in Diabetes Type 2 insulin experienced group and Diabetes Type 1 groups. Both insulins provided a similar reduction of HbA1c levels among patients with Diabetes Type 1 and Diabetes Type 2. Conclusion: In conclusion, this narrative review revealed that insulin degludec is superior to insulin glargine in terms of four safety and efficacy parameters such as change in fasting plasma glucose, body weight gain, nocturnal and overall hypoglycemia episodes. Degludec and glargine produced similar changes in HbA1c levels. The most pronounced differences in almost all the examined reviews were detected in the variables indicating nocturnal and overall hypoglycemia. The treatment with degludec also resulted in less hypoglycemia, accompanied with a better reduction of fasting plasma glucose levels. This characteristic confirms that degludec produces less glycemic variability and a close to physiological activity profile.