Insulin DEgludec in hospitalized patients with type 2 diabetes (IDEOS Study): what effects on glycemic control, glycemic variability and hypoglycemia

Modern guidelines suggest the control of hyperglycemia in hospitalized patients through insulin therapy and the achievement of individualized glycemic targets, avoiding hypoglycemia, associated with a worsening of outcomes and a mortality increase. There is little evidence in literature on the use of new basal insulins in a hospital setting. OBJECTIVE OF THE STUDY Document, in real life context, the use of insulin degludec and the results in terms of glycemic control, variability and hypoglycemia in hospitalized patients with type 2 diabetes, com pared to a population treated with traditional basal insulins. DESIGN AND METHODS Prospective observational study on patients hospitalized in internist area. Personal and clinical data, in particular capillary blood levels on 4 daily points and hypoglycemia were collect ed. In a group of patients on traditional basal insulin therapy not at tar get, a switch to insulin degludec was performed. RESULTS 65 patients (58.5% male) were enrolled: age 70.8±10.7 years, BMI 27.7 ± 4.4, HbA1c 8.4 ± 1.3% (average+/SD). 76.4% of patients had 3 or more comorbidities. 69.2% of patients were treated with basalbolus, 7.7% with basalplus, 16.9% with basal insulin alone. In the group treated with degludec (35 patients), a significant reduction in mean capillary glycaemia was obtained between the first day of hospitaliza tion or initiation of therapy and discharge in each time slot: 36.6 mg /dl fasting (p <0.0001), 30 mg/dl before lunch (p <0.005), 38.9 mg/dl before dinner (p <0.001) and 37.3 mg/dl bedtime (p <0.001) and also fewer hypoglycemia (20% had at least one daytime hypoglycemia, no subjects had nocturnal hypoglycaemia). In the group receiving insulin glargine for the entire period (30 patients), a significant reduction in capillary blood sugar levels is present only in the pre lunch range (43.8 mg / dl, p <0.001) and 26% of subjects had at least one daytime hypoglycemia and 2% nocturnal hypoglycemia. In the group switched to degludec, the mean capillary fasting blood glucose decreased from 176.6 ± 27.9 to 130.4 ± 36.6 mg/dl, that of predinner from 217.9 ± 36.7 to 170.9 ± 49.1 mg/dl, patients at target upon awakening increased from 10% to 65%, glycemic variability expressed as the mean of morning standard deviations fell from 45.2 to 25.6 and hypoglycemia decreased (% of patients with at least one daytime hypoglycemia from 25% to 15%, with nocturnal hypoglycemia from 5% to 0%). Conclusions The use of insulin degludec in hospitalized patients in medical area was effective and safe, with better glycemic control in every time slot, fewer hypoglycemia and reduced glycemic variability. KEY WORDS basal insulins; hospitalized patients; hypoglycemia; glycemic variability.