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Treating to target in type 2 diabetes: the BEGIN trial programme.

Subhash K Wangnoo, Subhankar Chowdhury, P V Rao

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    Insulin degludec, a new basal insulin, offers ultra-long action and similar glycemic control to insulin glargine. It demonstrates a reduced risk of nocturnal hypoglycemia and flexible dosing potential for type 1 and type 2 diabetes.

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    Area of Science:

    • Endocrinology
    • Pharmacology
    • Metabolic Diseases

    Background:

    • Insulin degludec is a novel basal insulin characterized by an ultra-long duration of action.
    • The global clinical trial program for insulin degludec and its combination with insulin aspart is the largest on record, involving over 11,000 patients across 40 countries.

    Purpose of the Study:

    • To evaluate the efficacy and safety of insulin degludec compared to insulin glargine in patients with type 1 or type 2 diabetes.
    • To assess the safety and glycemic control of insulin degludec with a flexible dosing regimen.
    • To investigate the utility of a 200 U/mL formulation for patients requiring high basal insulin volumes.

    Main Methods:

    • Phase 2 and 3a clinical trials were conducted globally, including the BEGIN and BOOST components.
    • Glycemic control was assessed through standard metrics.
    • Safety, including hypoglycemia rates, was a primary endpoint.

    Main Results:

    • Insulin degludec demonstrated comparable glycemic control to insulin glargine in type 1 and type 2 diabetes.
    • A significantly lower risk of nocturnal hypoglycemia was observed with insulin degludec.
    • Flexible dosing of insulin degludec maintained glycemic control and safety.
    • A 200 U/mL formulation was available for high-volume basal insulin needs.

    Conclusions:

    • Insulin degludec is a well-tolerated basal insulin offering an ultra-long duration of action.
    • It represents a valuable advancement in managing type 1 and type 2 diabetes, with benefits in reduced nocturnal hypoglycemia and dosing flexibility.