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Efficacy and safety of a fixed combination of insulin degludec/insulin aspart in children and adolescents with type 1 diabetes: A randomized trial.
Pediatr Diabetes 2018; 19(7):1263-1270PD

Abstract

BACKGROUND

Insulin degludec/insulin aspart (IDegAsp) is a fixed soluble co-formulation of basal and bolus insulin.

OBJECTIVE

To evaluate efficacy and safety of IDegAsp in pediatric patients with type 1 diabetes (T1D).

SUBJECTS

Children and adolescents (aged 1 to <18 years) with T1D.

METHODS

A 16-week, phase 3b, treat-to-target, parallel-group, open-label, non-inferiority trial was conducted at 63 sites in 14 countries from October 2013 to November 2014. Patients were randomized 1:1 (age stratified: 1-<6 years; 6-<12 years; 12-<18 years) to IDegAsp once daily (OD) plus insulin aspart (IAsp) for remaining meals (IDegAsp + IAsp), or IDet OD or twice daily plus mealtime IAsp (IDet + IAsp). The primary end-point was HbA1c change from baseline at week 16.

RESULTS

A total of 362 participants were randomized to IDegAsp + IAsp (n = 182) or IDet + IAsp (n = 180). HbA1c decreased from baseline to week 16 by 0.3% in both groups (estimated treatment difference: -0.04%-points [-0.23; 0.15]95%CI (-0.45 mmol/mol [-2.51; 1.60]95%CI), confirming non-inferiority. There were no significant differences between treatment groups in fasting or self-measured plasma glucose. Confirmed hypoglycemia rates did not significantly differ between groups. There was a significant reduction in basal and total insulin dose with IDegAsp + IAsp vs IDet + IAsp (post hoc analysis). Mean number of injections/day was 3.6 and 4.9 with IDegAsp + IAsp and IDet + IAsp, respectively (post hoc analysis). A non-significant higher rate of severe hypoglycemia was observed with IDegAsp + IAsp vs IDet + IAsp. The most frequent adverse events in both groups were hypoglycemia, headache, and nasopharyngitis.

CONCLUSIONS

IDegAsp + IAsp was non-inferior to IDet + IAsp regarding HbA1c, had similar hypoglycemia rates and required fewer injections.

Authors+Show Affiliations

Department of Endocrinology, Diabetes and Metabolism, UMC - University Children's Hospital, Ljubljana, Slovenia. Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.Florida State University College of Medicine, Tallahassee, Florida.Novo Nordisk A/S, Søborg, Denmark.Novo Nordisk A/S, Bagsvaerd, Denmark.Barbara Davis Center for Childhood Diabetes, University of Colorado and Children's Hospital Colorado, Aurora, Colorado.Department of Endocrinology & Genetics, University Pediatric Clinic- Skopje, Skopje, Republic of Macedonia.Pediatric Department, Novosibirsk State Medical University of The Ministry of Healthcare of the Russian Federation, Novosibirsk, Russia.Rambam Health Care Campus, Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30014589

Citation

Battelino, Tadej, et al. "Efficacy and Safety of a Fixed Combination of Insulin Degludec/insulin Aspart in Children and Adolescents With Type 1 Diabetes: a Randomized Trial." Pediatric Diabetes, vol. 19, no. 7, 2018, pp. 1263-1270.
Battelino T, Deeb LC, Ekelund M, et al. Efficacy and safety of a fixed combination of insulin degludec/insulin aspart in children and adolescents with type 1 diabetes: A randomized trial. Pediatr Diabetes. 2018;19(7):1263-1270.
Battelino, T., Deeb, L. C., Ekelund, M., Kinduryte, O., Klingensmith, G. J., Kocova, M., ... Shehadeh, N. (2018). Efficacy and safety of a fixed combination of insulin degludec/insulin aspart in children and adolescents with type 1 diabetes: A randomized trial. Pediatric Diabetes, 19(7), pp. 1263-1270. doi:10.1111/pedi.12724.
Battelino T, et al. Efficacy and Safety of a Fixed Combination of Insulin Degludec/insulin Aspart in Children and Adolescents With Type 1 Diabetes: a Randomized Trial. Pediatr Diabetes. 2018;19(7):1263-1270. PubMed PMID: 30014589.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy and safety of a fixed combination of insulin degludec/insulin aspart in children and adolescents with type 1 diabetes: A randomized trial. AU - Battelino,Tadej, AU - Deeb,Larry C, AU - Ekelund,Magnus, AU - Kinduryte,Ona, AU - Klingensmith,Georgeanna J, AU - Kocova,Mirjana, AU - Kovarenko,Margarita, AU - Shehadeh,Naim, Y1 - 2018/08/16/ PY - 2018/01/29/received PY - 2018/05/30/revised PY - 2018/07/10/accepted PY - 2018/7/18/pubmed PY - 2019/5/31/medline PY - 2018/7/18/entrez KW - adolescent KW - child KW - insulin degludec/insulin aspart KW - insulin detemir KW - type 1 diabetes SP - 1263 EP - 1270 JF - Pediatric diabetes JO - Pediatr Diabetes VL - 19 IS - 7 N2 - BACKGROUND: Insulin degludec/insulin aspart (IDegAsp) is a fixed soluble co-formulation of basal and bolus insulin. OBJECTIVE: To evaluate efficacy and safety of IDegAsp in pediatric patients with type 1 diabetes (T1D). SUBJECTS: Children and adolescents (aged 1 to <18 years) with T1D. METHODS: A 16-week, phase 3b, treat-to-target, parallel-group, open-label, non-inferiority trial was conducted at 63 sites in 14 countries from October 2013 to November 2014. Patients were randomized 1:1 (age stratified: 1-<6 years; 6-<12 years; 12-<18 years) to IDegAsp once daily (OD) plus insulin aspart (IAsp) for remaining meals (IDegAsp + IAsp), or IDet OD or twice daily plus mealtime IAsp (IDet + IAsp). The primary end-point was HbA1c change from baseline at week 16. RESULTS: A total of 362 participants were randomized to IDegAsp + IAsp (n = 182) or IDet + IAsp (n = 180). HbA1c decreased from baseline to week 16 by 0.3% in both groups (estimated treatment difference: -0.04%-points [-0.23; 0.15]95%CI (-0.45 mmol/mol [-2.51; 1.60]95%CI), confirming non-inferiority. There were no significant differences between treatment groups in fasting or self-measured plasma glucose. Confirmed hypoglycemia rates did not significantly differ between groups. There was a significant reduction in basal and total insulin dose with IDegAsp + IAsp vs IDet + IAsp (post hoc analysis). Mean number of injections/day was 3.6 and 4.9 with IDegAsp + IAsp and IDet + IAsp, respectively (post hoc analysis). A non-significant higher rate of severe hypoglycemia was observed with IDegAsp + IAsp vs IDet + IAsp. The most frequent adverse events in both groups were hypoglycemia, headache, and nasopharyngitis. CONCLUSIONS: IDegAsp + IAsp was non-inferior to IDet + IAsp regarding HbA1c, had similar hypoglycemia rates and required fewer injections. SN - 1399-5448 UR - https://www.unboundmedicine.com/medline/citation/30014589/Efficacy_and_safety_of_a_fixed_combination_of_insulin_degludec/insulin_aspart_in_children_and_adolescents_with_type_1_diabetes:_A_randomized_trial_ L2 - https://doi.org/10.1111/pedi.12724 DB - PRIME DP - Unbound Medicine ER -