Randomized, double‐blind clinical trial comparing basal insulin peglispro and insulin glargine, in combination with prandial insulin lispro, in patients with type 1 diabetes: IMAGINE 3. Issue 11 (3rd August 2016)

• Record Type: Journal Article
• Authors: Bergenstal, R. M.; Lunt, H.; Franek, E.; Travert, F.; Mou, J.; Qu, Y.; Antalis, C. J.; Hartman, M. L.; Rosilio, M.; Jacober, S. J.; Bastyr, E. J.
• Is Part Of: Diabetes, obesity & metabolism. Volume 18:Issue 11(2016)
• Page Start: 1081
• Page End: 1088
• Publication Date: 2016-08-03
• Subjects: basal insulin -- glycaemic control -- hypoglycaemia -- randomized trial -- type 1 diabetes; Diabetes -- Periodicals; Obesity -- Periodicals; Metabolism -- Disorders -- Periodicals; Clinical pharmacology -- Periodicals; 616.462
• DOI: 10.1111/dom.12698
• Languages: English
• ISSNs: 1462-8902

Abstract

Abstract : Aims: To compare the efficacy and safety of basal insulin peglispro (BIL), which has a flat pharmacokinetic and pharmacodynamic profile and a long duration of action, with insulin glargine (GL) in patients with type 1 diabetes. Materials and methods: In this phase III, 52‐week, blinded study, we randomized 1114 adults with type 1 diabetes in a 3 : 2 distribution to receive either BIL (n = 664) or GL (n = 450) at bedtime, with preprandial insulin lispro, using intensive insulin management. The primary objective was to compare glycated haemoglobin (HbA1c) in the groups at 52 weeks, with a non‐inferiority margin of 0.4%. Results: At 52 weeks, mean (standard error) HbA1c was 7.38 (0.03)% with BIL and 7.61 (0.04)% with GL {difference −0.22% [95% confidence interval (CI) −0.32, −0.12]; p < 0.001}. At 52 weeks more BIL‐treated patients reached HbA1c <7% (35% vs 26%; p < 0.001), the nocturnal hypoglycaemia rate was 47% lower (p < 0.001) and the total hypoglycaemia rate was 11% higher (p = 0.002) than in GL‐treated patients, and there was no difference in severe hypoglycaemia rate. Patients receiving BIL lost weight, while those receiving GL gained weight [difference −1.8 kg (95% CI −2.3, −1.3); p < 0.001]. Treatment with BIL compared with GL at 52 weeks was associated with greater increases from baseline in levels of serum triglyceride [difference 0.19 mmol/l (95% CI 0.11, 0.26); p < 0.001] and alanine aminotransferase (ALT) levels [difference 6.5 IU/l (95% CI 4.1, 8.9), p < 0.001], and more frequent injection site reactions. Conclusions: In patients with type 1 diabetes, treatment with BIL compared with GL for 52 weeks resulted in a lower HbA1c, more patients with HbA1c levels <7%, and reduced nocturnal hypoglycaemia, but more total hypoglycaemia and injection site reactions and higher triglyceride and ALT levels.