<h2>BRIGHT Research</h2>
The Bright study demonstrated similar efficacy and safety of Toujeo®&nbsp;(Glargine 300) compared to degludec (Glargine 100) in type 2 diabetes patients who had not previously received basal insulin1.

Primary Endpoint

To assess the change in HbA1C from baseline to week 24, determining non-inferiority between Toujeo and degludec.1

Safety Endpoint

Incidence and event rates of hypoglycemia during the 24-week on-treatment period, the active titration period (Weeks 0&ndash;12), and the maintenance period (Weeks 13&ndash;24).1

<h2>Key findings</h2>
<ul>
 <li>Glycemic Control: The participants achieved similar reductions in HbA1c levels by week 24, demonstrating non-inferiority of Toujeo compared to degludec.1</li>
</ul>

<ul>
 <li>Hypoglycemia Rates: During the initial 12-week titration phase, the incidence of confirmed hypoglycemia was significantly lower in the Toujeo group compared to the degludec group.1</li>
</ul>

The BRIGHT study concluded that Toujeo provides similar glycemic control to insulin degludec in insulin-naïve adults with type 2 diabetes. Notably, Toujeo was associated with a lower incidence of hypoglycemia during the initial titration phase, suggesting a potential advantage in the early stages of insulin initiation.

Referenties and Footnotes

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BRIGHT publication

TYPE-2-DIABETES

DIABETES

EASD and ADA recommend the addition of basal insulin for people with T2DM who do not achieve glycemic goals on a GLP-1 RA-based regimen.*2,3
RESTORE-G: Real-world analysis in insulin-naïve adults with T2DM on GLP-1 RA ± OAD(s), intensifying their therapy by starting basal insulin and discontinuing GLP-1 RA, or adding basal insulin to ongoing GLP-1 RA, or initiating a FRC product and discontinuing current GLP-1 RA†1.
~40% of people with T2DM on GLP-1 RA required intensification with basal insulin after a median of ~2 years (primary endpoint).‡1&nbsp;Following intensification with basal insulin, a significant reduction in HbA1c was seen§ and no severe hypoglycemia was recorded.¥1
Toujeo®&nbsp;was associated with greater HbA1c&nbsp;and FBG reductions, and similar weight change vs degludec, in people with T2DM switching from GLP-1 RA therapy to basal insulin.

<h4>Greater HbA1c&nbsp;reduction with Toujeo®&nbsp;vs degludec was also seen in the propensity score matched sensitivity analysis (p=0.02)†‡1</h4>

Baseline characteristics of the populations selected for the comparative effectiveness analysis of Toujeo®&nbsp;vs degludec1

Study design

Identification of cohorts eligible for predefined and post-hoc comparative effectiveness sub-analyses1,2

Baseline characteristics of the populations selected for the comparative effectiveness analysis of 2nd&nbsp;vs 1st generation BIs1

RESTORE-G: Real-world analysis in insulin-naïve adults with T2D on GLP-1 RA ± OAD(s), intensifying their therapy by starting basal insulin and discontinuing GLP-1 RA, or adding basal insulin to ongoing GLP-1 RA, or initiating a FRC product and discontinuing current GLP-1 RA†2

The RESTORE-G Real World Evidence Study

<h2>Switching from other basal insulins to Toujeo® (Insulin Glargine)</h2>

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<h2>How to switch from other basal insulins to Toujeo®1,2</h2>

Toujeo DoubleStar®&nbsp;this pen has 900 units3&nbsp;and up to 160 units in one injection2.

The&nbsp;Toujeo SoloStar®&nbsp;pen has 450 units2&nbsp;and up to 80 units in one injection2.

<h2>Switching from Glargine 100 (e.g. Lantus®) to Glargine 300 (e.g. Toujeo®)</h2>

<h2>Switching from NPH/other basal insulin (e.g. Insulatard) to Toujeo®</h2>
When switching from NPH insulin to Toujeo®, the starting dose depends on whether the patient has taken the NPH insulin once or twice a day.&nbsp;

For example, if the person has taken 2 x 40 U Insulatard = 80 U, they should start with a dose of 64 U Toujeo®&nbsp;once a day.&nbsp;

<h2>With Toujeo®, you can effectively titrate your patients to the target of 4.5-6.0 mmol/L1</h2>
The dose is adjusted every 7 days,&nbsp;based on the median of the patient's last 3 fasting blood glucose measurements.
The titration algorithm is for illustrative use and&nbsp;adaptation with regard to the individual and goal of treatment is necessary.

References

Switching from other basal insulins to Toujeo® (Insulin Glargine)

Managing glycaemic levels in type 2 diabetes (T2D) is crucial to reducing the risk of vascular complications and mortality. The study by Zoungas et al., published in Diabetologia in 2012, investigates the relationship between HbA1c levels and the risks of macrovascular and microvascular events, as well as death, in patients with T2D. This summary highlights the key findings and their implications for clinical practice.

<h2>Study Overview</h2>
The study analyzed data from 11,140 participants in the ADVANCE trial, a large-scale, randomized controlled trial. Participants were assigned to either intensive or standard glucose control, and their HbA1c levels were monitored over time. The study aimed to identify glycaemic thresholds associated with increased risks of vascular complications and death.
<h2>Key Findings</h2>
<ol>
 <li>Non-linear Relationship 
 The study found a non-linear relationship between HbA1c levels and the risks of macrovascular events, microvascular events, and death. This means that the risk did not increase uniformly with higher HbA1c levels. 
 &nbsp;</li>
 <li>Thresholds Identified
 <ul>
 <li>Macrovascular Events and Death: 
 Risks increased significantly above an HbA1c level of 7.0%. Below this threshold, there was no significant change in risk.</li>
 <li>Microvascular Events: 
 Risks increased significantly above an HbA1c level of 6.5%. Below this threshold, there was no significant change in risk. 
 &nbsp;</li>
 </ul></li>
 <li>Risk Increase 
 For every 1% increase in HbA1c above these thresholds, the risk of macrovascular events increased by 38%, microvascular events by 40%, and death by 38%.</li>
</ol>

The study by Zoungas et al. provides evidence of specific glycaemic thresholds above which the risks of vascular complications and death increase significantly in patients with T2D. These findings suggest that maintaining HbA1c levels below 7.0% for macrovascular events and death, and below 6.5% for microvascular events, is crucial for minimizing risks.

<h2>Clinical implications for General Practice</h2>
Healthcare providers should aim to:

Regularly monitor HbA1c levels to ensure they remain below the identified thresholds.

Tailor treatment plans to maintain HbA1c levels within the optimal range for each patient.

Emphasize the importance of glycaemic control and educate patients on how to achieve and maintain target HbA1c levels.

By focusing on these areas, healthcare providers can help reduce the risk of vascular complications and improve outcomes for patients with T2D.

READ THE FULL STUDY HERE

Summary of Zoungas S, et al. Diabetologia. 2012;55:636–643.

Glycaemic Targets and Vascular Complications in Type 2 Diabetes: What Are the Thresholds?

The 2022 guidelines from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) provide evidence-based recommendations on managing type 2 diabetes, focusing on the use of basal insulin when patients fail to achieve glycemic control through other methods. The article outlines when and how to initiate basal insulin, offering practical steps for general practitioners (GPs) to implement these strategies effectively.

Watch the video below or read the summary including selected highlights from the guidelines, and a link to the full overview.

Practical Guidance based on the 2022 ADA/EASD Guidelines.

When to Initiate Basal Insulin?

<h2>When to Initiate Basal Insulin?</h2>
The ADA/EASD 2022 guidelines recommend considering basal insulin for type 2 diabetes patients who are unable to achieve adequate glycemic control (generally an HbA1c above 7.0%) despite the use of multiple oral agents or GLP-1 receptor agonists. For GPs, this typically involves monitoring patients with consistently elevated fasting plasma glucose levels (over 13.9 mmol/L) or an HbA1c level exceeding 86 mmol/mol (10%), as well as those presenting with symptoms of catabolism (e.g., weight loss, increased thirst, and urination).
The guidelines suggest that GPs initiate basal insulin with a long-acting preparation, starting at a low dose (e.g., 10 IU daily or 0.1–0.2 IU/kg/day). Close monitoring and gradual titration based on fasting glucose levels (aiming for 4.4-7.2 mmol/L) help minimize the risk of hypoglycemia. GPs are encouraged to adapt this approach to each patient, considering factors like age, duration of diabetes, other medical conditions, and the individual’s lifestyle.
<h2>Clinical Implications for General Practice</h2>
The updated guidelines highlight the importance of early and individualized interventions for GPs managing type 2 diabetes patients. Starting basal insulin when oral therapies are insufficient helps maintain glycemic targets and prevents complications such as cardiovascular issues, neuropathy, and retinopathy. GPs should remain proactive in monitoring progress, adjusting doses, and providing patient education on insulin management to optimize care outcomes.

For further details and guidance, consult the full 2022 ADA/EASD guidelines available <a href="https://www.diabetesjournals.org/" target="_blank">here</a>.

Practical Guidance based on the 2022 ADA/EASD Guidelines.

Type 2 diabetes (T2D) is a chronic metabolic disorder characterized by hyperglycemia due to insulin resistance and, eventually, inadequate insulin secretion. It poses significant health risks, contributing to cardiovascular diseases, renal dysfunction, neuropathy, and retinopathy. Proper glycemic control remains fundamental in managing T2D, as it can prevent or delay these long-term complications. The article by Stratton et al. emphasizes the importance of maintaining optimal glycemic levels and reviews the evidence supporting the early and sustained management of blood glucose to minimize these risks.
<h2>Key Highlights</h2>
<ol>
 <li>Evidence for Glycemic Control and its Role in Preventing Complications 
 The article underscores the crucial role of glycemic control in reducing complications associated with T2D. It references landmark trials, such as the UKPDS, that demonstrated how intensive glycemic management can significantly lower the risk of microvascular complications like retinopathy, nephropathy, and neuropathy. By targeting an HbA1c level of less than 7%, healthcare professionals (HCPs) can help patients avoid or delay these severe outcomes. 
 &nbsp;</li>
 <li>Macrovascular Benefits of Glycemic Control 
 Although the link between glycemic control and macrovascular outcomes (e.g., cardiovascular events) is complex, the article indicates that achieving and maintaining glycemic targets early in the disease progression can offer some protective effects. It highlights how the “legacy effect” or “metabolic memory” suggests that intensive early intervention can have lasting benefits, even when glycemic levels fluctuate later. 
 &nbsp;</li>
 <li>The Balance Between Efficacy and Safety 
 While aggressive glycemic management can reduce complications, it is crucial for HCPs to balance efficacy with safety, particularly in patients with long-standing diabetes or those at risk for hypoglycemia. The article discusses how personalized treatment strategies, including the selection of pharmacologic agents and the use of continuous glucose monitoring, can help optimize outcomes while minimizing adverse events. 
 &nbsp;</li>
 <li>Patient-Centered Approach 
 The article advocates for a patient-centered approach to glycemic control, emphasizing the need to individualize targets and therapies based on patient characteristics, comorbidities, and lifestyle factors. It encourages HCPs to involve patients in decision-making, set realistic goals, and provide ongoing education to promote adherence to treatment plans.</li>
</ol>
<h2>Conclusion</h2>

Achieving and maintaining optimal glycemic control is essential in the management of T2D to prevent long-term complications. This article provides robust evidence supporting early and intensive glycemic intervention while emphasizing the importance of individualized care. For HCPs, staying informed and proactive in managing blood glucose levels is key to improving patient outcomes and reducing the burden of diabetes-related complications.

(Based on the study: Stratton IM, et al. BMJ. 2000;321(7258):405-12).

Is Glycemic Control the Key to Preventing Long-term Complications in Type 2 Diabetes?

The UK Prospective Diabetes Study (UKPDS) is a landmark study that has significantly influenced the management of type 2 diabetes (T2D). The study by Stratton et al., published in BMJ in 2000, explores the relationship between glycaemic control and the risk of macrovascular and microvascular complications in patients with T2D. This summary highlights the key findings and their implications for clinical practice.
The UKPDS was a prospective observational study involving 4,585 patients with newly diagnosed T2D. The study aimed to determine how long-term glycaemic control, measured by HbA1c levels, affects the incidence of various diabetic complications. Data were collected over a median follow-up period of 10 years.
<h2>Key Highlights</h2>
<ol>
 <li>Risk Reduction: 
 Each 1% reduction in updated mean HbA1c was associated with significant reductions in the risk of complications: 
 &nbsp; 
 <ul>
 <li>21% reduction in any diabetes-related endpoint.</li>
 <li>21% reduction in diabetes-related deaths.</li>
 <li>14% reduction in myocardial infarction.</li>
 <li>37% reduction in microvascular complications.</li>
 </ul></li>
</ol>

<ol>
 <li>Hide</li>
 <li>No Threshold Effect: 
 The study found no specific HbA1c threshold below which the risk of complications markedly decreased. Instead, the risk of complications continuously decreased with lower HbA1c levels. 
 &nbsp;</li>
 <li>Consistent Benefits: 
 The benefits of improved glycaemic control were consistent across different types of complications, emphasizing the importance of maintaining lower HbA1c levels to reduce overall risk.</li>
</ol>

The UKPDS demonstrates that better glycaemic control significantly reduces the risk of both macrovascular and microvascular complications in patients with T2D. The findings support the goal of achieving and maintaining lower HbA1c levels to minimize the risk of complications and improve patient outcomes.

<h2>Clincal implications for General Practice</h2>
Healthcare providers should focus on:

Strive to maintain HbA1c levels as low as safely possible to reduce the risk of complications.

Conduct frequent HbA1c testing to ensure glycaemic targets are met.

Implement a holistic approach to diabetes care, including lifestyle modifications, patient education, and appropriate pharmacotherapy.

By prioritizing these strategies, healthcare providers can help patients with T2D achieve better glycaemic control and reduce the incidence of diabetes-related complications.

Summary of The UK Prospective Diabetes Study (UKPDS).

How Does Glycaemic Control Impact Complications in Type 2 Diabetes?

Type 2 diabetes (T2D) remains a significant global health challenge, particularly in developing countries. The International Diabetes Management Practices Study (IDMPS) provides valuable real-world evidence on the management and outcomes of T2D over a 12-year period. This article summarizes key findings from the IDMPS, highlighting trends in glycaemic control, therapy use, and care practices.

<h2>When to Initiate Basal Insulin?</h2>
The IDMPS collected data from 66,088 individuals with T2D across 49 countries, involving 6099 physicians. The study spanned seven cross-sectional waves from 2005 to 2017, with each physician collecting data from ten consecutive patients during a two-week period.
<h2>Key Findings</h2>
<ol>
 <li>Glycaemic Control: 
 The proportion of participants achieving HbA1c &lt;7% decreased from 36% in 2005 to 30.1% in 2017. This decline underscores persistent challenges in achieving optimal glycaemic control. 
 &nbsp;</li>
 <li>Therapy Use: 
 Over 80% of participants were on oral glucose-lowering drugs (OGLDs), with a notable decline in sulfonylurea use. Insulin use increased from 32.8% to 41.2%, with a slight reduction in the time to insulin initiation. 
 &nbsp;</li>
 <li>Diabetes Education: 
 The proportion of participants receiving diabetes education rose from 59.0% to 78.3%, reflecting an increased emphasis on patient education and self-management. 
 &nbsp;</li>
 <li>Monitoring: 
 The frequency of HbA1c measurements improved significantly, with 92.9% of participants having at least two measurements within 12 months by the final wave.</li>
</ol>

Despite advancements in diabetes management, glycaemic control in developing countries remains suboptimal. The IDMPS highlights the need for systemic changes and better organization of care to improve outcomes for individuals with T2D. Enhanced diabetes education, timely therapy adjustments, and regular monitoring are crucial for achieving better glycaemic control and reducing the burden of diabetes-related complications.

<h2>Clincal implications for General Practice</h2>
Healthcare providers play a pivotal role in managing T2D. The findings from the IDMPS emphasize the importance of:

Ensuring frequent HbA1c testing to track glycaemic control.

Providing comprehensive diabetes education to empower patients in self-management.

Tailoring treatment plans to individual patient needs, including timely initiation and adjustment of insulin therapy.

By addressing these areas, healthcare providers can significantly improve the quality of care for patients with T2D, ultimately leading to better health outcomes.
This summary provides a concise overview of the IDMPS findings and their implications for healthcare providers. For more detailed information, refer to the original article by Aschner et al. in Diabetologia.

Summary of Aschner P, et al. Diabetologia. 2020;63(4):711-721.

Why is Glycaemic Control in Type 2 Diabetes Still a Challenge?

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Diabetes type 2

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