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Reduced hypoglycaemia using liver-targeted insulin in individuals with type 1 diabetes
Ruth S Weinstock1, Bruce W Bode2, Satish K Garg3
1SUNY Upstate Medical University, Syracuse, New York.
Diabetes, Obesity & Metabolism
|May 13, 2022
Summary
Liver-targeted bolus insulin (BoI) use increased, reducing hypoglycemic events (HEv) in type 1 diabetes. Increasing the bolus to basal insulin ratio (BBR) by lowering basal insulin safely enhanced BoI delivery and efficacy.
Area of Science:
- Diabetes management
- Pharmacology
- Metabolic disorders
Background:
- Type 1 diabetes requires careful insulin management to prevent hyperglycemia and hypoglycemia.
- Traditional insulin therapy involves basal and bolus insulin, with the ratio influencing glycemic control.
- Hypoglycemic events (HEv) remain a significant challenge in insulin therapy.
Purpose of the Study:
- To evaluate if an increased bolus to basal insulin ratio (BBR) using liver-targeted bolus insulin (BoI) improves BoI utilization.
- To determine if this strategy reduces hypoglycemic events (HEv) in individuals with type 1 diabetes.
Main Methods:
- 52 individuals with type 1 diabetes on multiple daily injections were studied.
- Hepatic-directed vesicle (HDV) technology delivered BoI to the liver.
- Participants were randomized to a 10% or 40% reduction in basal insulin (BaI) after a 90-day run-in period.
Main Results:
- Total insulin dosing increased by ~7% in both cohorts.
- The -10% and -40% BaI cohorts showed 7.7% and 13% greater BoI use, respectively.
- Nocturnal level 2 HEv decreased by 21% and 43%, with patient-reported HEv reductions of 54% and 59%.
Conclusions:
- Liver-targeted BoI safely reduces hypoglycemic events and symptoms without compromising glucose control.
- Increasing the BBR by lowering BaI dosing is safe and leads to increased BoI usage.
- This approach offers a promising strategy for improving insulin therapy in type 1 diabetes.
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