Use of insulin glargine in type 1 diabetes tied to reduced time in hypoglycemia after exercise: Study

Austria: People with type 1 diabetes receiving insulin glargine U-300 (IGlar U300) had a significantly lower time spent in hypoglycemia after spontaneous exercise sessions versus people receiving insulin degludec (IfDEG) at the 100% dose, says a recent study. The study appears in Diabetes, the journal of the American Diabetes Association. 

Regular exercise and physical activity represent a cornerstone in type 1 diabetes (T1D) treatment. Exercise-induced hypoglycemia however remains the major barrier to a physically active lifestyle. Therefore, study author Harald Sourij, Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Medical University of Graz, Austria, and colleagues in their ULTRAFLEXI-1 study compared two basal insulin analogs, Glargine 300U/ml and Degludec in two different doses (100% and 75% of the regular dose) when used around spontaneous exercise sessions in adults with T1D. 

For this purpose, they performed a randomized, single-center, four-period, cross-over trial and included adults with T1D treated with multiple daily insulin injections and an HbA1c ≤10% (≤86 mmol/mol). Participants attended six spontaneous evening cycling sessions (60 minutes, moderate intensity) in each of the four 2-weeks-periods. Exercise days were randomized and announced at 8 A.M. to the participants. 

During the four periods, the basal insulin used on the exercise days was: IGlar U300 100% or 75% of the regular dose or IDeg 100% or 75%, respectively. On all non-exercise days, 100% of the regular basal insulin dose was used. A blinded Dexcom G6 device was used to perform CGM. 

The primary outcome was TBR (<70 mg/dl) during the six 24-hour post-exercise periods in the four trial arms. Using the repeated measures linear mixed model, the difference in TBR between 100% IGlar and 100% IDeg or 75% IGlar and 75% IDeg was analyzed in hierarchical order. 

The researchers conclude, "time spent in hypoglycemia after spontaneous exercise sessions were significantly lower in type 1 diabetes patients receiving IGlar U300 as compared to IDeg when the 100% dose was used."

Reference:

OTHMAR MOSER, ALEXANDER MUELLER, FELIX ABERER, FAISAL AZIZ, HARALD KOJZAR, CAREN SOURIJ, ANNA M. OBERMAYER, FARAH M. ABBAS, PHILIPP BIRNBAUMER, MAX L. ECKSTEIN, LUKAS HÖNGER, JACQUELINE LENZ, INES MURSIC, CHRISTOPH STERNAD, MATTHIAS ZANKER, HARIS ZIKO, PETER N. PFERSCHY, NORBERT J. TRIPOLT, HARALD SOURIJ; 39-LB: A Comparison of Insulin Glargine U300 and Insulin Degludec around Spontaneous Exercise Sessions in People with Type 1 Diabetes—The ULTRAFLEXI-1 Study. Diabetes 1 June 2022; 71 (Supplement_1): 39–LB. https://doi.org/10.2337/db22-39-LB