Insulin glargine lowered dangerous hypoglycemia in youth trial
A trial in Bangladesh and Tanzania found delayed safety benefits from a newer long-acting insulin for young people with type 1 diabetes.
By Tom Brennan · Health & Medicine Correspondent
3 min read
A newer long-acting insulin reduced time spent with dangerously low blood sugar after one year in a trial of young people with type 1 diabetes in Bangladesh and Tanzania. The findings matter for health systems weighing whether higher-cost insulin analogs should be prioritized where access to diabetes care is limited.
The randomized clinical trial, led by University of Pittsburgh researchers and published in The Lancet Diabetes & Endocrinology, enrolled 400 participants ages 7 to 25. Researchers compared insulin glargine, a long-acting analog, with usual care using older human insulin.
At six months, the study found no evidence that glargine performed better on its two main measures: time spent in a very low glucose range and time spent in the target glucose range. By 12 months, participants assigned to glargine spent less time in the very low glucose range and had fewer nighttime hypoglycemic events than those receiving usual care, according to the University of Pittsburgh Schools of the Health Sciences.
The researchers reported no meaningful 12-month differences between groups in time in range, HbA1c, diabetic ketoacidosis, severe hypoglycemic events or symptomatic hypoglycemic events. That pattern points to a narrower benefit than a broad improvement across glucose control measures.
Jing Luo, the study’s lead author and an associate professor of medicine at the University of Pittsburgh, said the trial adds evidence to decisions about buying, access and clinical guidance in countries where treatment choices are restricted by cost and supply. Luo said the issue is whether the benefits seen in the study are strong enough to influence those decisions.
The 12-month results suggest that safety gains tied to serious low blood sugar may take time to appear after patients switch to analog insulin in low-resource care settings, according to the Pittsburgh team. The study also found that glargine was linked with lower total daily insulin use and fewer injections per day.
Those practical effects could be relevant for patients, caregivers and health systems, although the study did not find that glargine improved the primary outcomes at the six-month mark. The authors said more research is needed to understand longer-term glycemic outcomes after people in low-resource settings move from older human insulin to analog insulin.
The World Health Organization added long-acting insulin analogs such as glargine to its Model List of Essential Medicines in 2021. Even so, the University of Pittsburgh noted that type 1 diabetes care remains uneven across countries.
About 9.5 million people worldwide are estimated to live with type 1 diabetes, and roughly 3.2 million are treated only with older human insulins, most of them in low- and middle-income countries, according to figures cited by the Pittsburgh researchers. Long-acting analogs are common in wealthier countries, but their higher price and limited availability have slowed use elsewhere.
Luo said many children around the world still lack access to treatments considered standard in other places. He said the results add data to the debate over whether resource-limited health systems should expand access to newer insulin formulations despite their cost.
This story draws on original reporting from Medical Xpress.