Insulin degludec and insulin glargine 300 U/mL: Which of these two insulins causes less hypoglycemia?

Abstract

The interesting article by Yamabe et al.1 showed, using continuous glucose monitoring, that insulin degludec (I‐Deg) was associated with a high percentage of time with nocturnal hypoglycemia than with insulin glargine 300 U/mL (I‐G300; P = 0.02). However, we observe that some possible confounding factors might have influenced the results, such as differences in concomitant medications, use of the same titration protocol for both kinds of insulin or differences in glucose levels. This is also a recurrent problem in clinical trials, which sometime produce conflicting results. In fact, the study of Yamabe et al. is partly in agreement with some recently published clinical trials that gave different conclusions. In the last months of 2018, three studies2, 3, 4 compared I‐Deg with I‐G300 using different approaches, but their conclusions were quite different, especially regarding the possibility of inducing hypoglycemia