Evaluating the Effectiveness of Switching to Insulin Degludec from Other Basal Insulins in a Real-World Canadian Population with Type 1 or Type 2 Diabetes: The CAN-TREAT Study

Introduction The aim of the study was to examine glycaemic control and safety of insulin degludec (degludec) in patients with either type 1 diabetes (T1D) or type 2 diabetes (T2D) under routine care settings in Canada. Methods Data were extracted from medical records of adults with T1D or T2D who switched to degludec (± prandial insulin) from another basal insulin (± prandial insulin) ≥ 6 months prior to data collection. The primary endpoint was change in glycated haemoglobin (HbA 1c ) at 6 ± 3 months after degludec initiation. Secondary endpoints included change in hypoglycaemia rate in the 6 months before versus the 6 months after switching, and change in mean total daily insulin dose. Results Of 667 patients assessed for eligibility, 626 were included. After 6 ± 3 months, HbA 1c decreased from baseline in patients with T1D (− 0.3% [− 0.42, − 0.14] 95% CI ; p < 0.001) and in patients with T2D (− 0.4% [− 0.55, − 0.30] 95% CI ; p < 0.001). In patients with T1D, there were significant reductions in the rates of overall (rate ratio [RR] 0.70), non-severe (RR 0.69), non-severe nocturnal (RR 0.36), and severe nocturnal hypoglycaemia (RR 0.12; all p ≤ 0.004). In patients with T2D there was a significant reduction in non-severe nocturnal hypoglycaemia (RR 0.22; p < 0.001). Mean daily basal insulin dose decreased in patients with T1D (− 1.6 units [− 2.8, − 0.4] 95% CI ; p = 0.008); there was no significant change in patients with T2D (− 0.6 units [− 2.7, 1.4] 95% CI ; p = 0.543). Conclusion In routine clinical practice, improved glycaemic control was observed in patients with T1D or T2D switching to insulin degludec from other basal insulins, with either improvement or no change in hypoglycaemia rates. Trial Registration ClinicalTrials.gov NCT03674866