Response: Favorable Glycemic Control with Once-Daily Insulin Degludec/Insulin Aspart after Changing from Basal Insulin in Adults with Type 2 Diabetes (Endocrinol Metab 2019; 34:382-9, Han Na Jang et al.)

Response: Favorable Glycemic Control with Once-Daily Insulin Degludec/Insulin Aspart after... Endocrinol Metab 2020;35:194-195 https://doi.org/10.3803/EnM.2020.35.1.194 Response pISSN 2093-596X · eISSN 2093-5978 Favorable Glycemic Control with Once-Daily Insulin Degludec/Insulin Aspart after Changing from Basal Insulin in Adults with Type 2 Diabetes (Endocrinol Metab 2019; 34:382-9, Han Na Jang et al.) Han Na Jang, Hye Seung Jung Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Thank you so much for your interest in our paper and for your study. As you pointed out, precise measurements of the gap be- insightful comments on it. Our paper suggests that once-daily tween predicted and measured FPG should be performed in a insulin degludec/insulin aspart (IDegAsp) can control blood large cohort. glucose levels better than once-daily basal insulin, especially for As you mentioned, GLP-1 agonists are beneficial for post- patients with severe insulin deficiency and high blood glucose prandial blood glucose control and have a cardiovascular pro- variation [1]. tective effect [2], so the use of a combination of basal insulin As you pointed out, this study has the limitations of a retro- and a GLP-1 agonist can effectively control postprandial blood spective design, a small number of patients, and a short follow- glucose and obtain cardiovascular protective effects without in- up duration. Therefore, we acknowledge that the conclusions of creasing the number of injections [3]. However, there are still this study are not fully definitive; instead, we interpret the re- patients in whom it is difficult to use a GLP-1 agonist due to a sults as suggesting the need to conduct further research to iden- low glomerular filtration rate or adverse effects such as gastro- tify an indicator of the subset of patients who obtain more bene- intestinal troubles [2]. Most of all, the eventual failure of GLP-1 fits by changing from basal insulin to IDegAsp. This would be a therapy leads to multiple daily insulin injections, which would significant advance because IDegAsp has failed to demonstrate involve a mixed regimen such as IDegAsp [4]. superiority to basal insulin in the broader population of insulin- Thank you again for your comments on our paper. If you have dependent patients with diabetes. Based on this pilot study, we any other comments or questions, please feel free to contact me. are planning to perform a randomized controlled trial compar- ing IDegAsp to basal insulin in patients with a high gap between CONFLICTS OF INTEREST the predicted fasting plasma glucose (FPG) level and the mea- sured FPG. With concurrent analysis using continuous glucose No potential conflict of interest relevant to this article was re- monitors, we expect to elucidate the relationship between the ported. effects of IDegAsp and glycemic variability in this upcoming Received: 18 February 2020, Accepted: 21 February 2020 Copyright © 2020 Korean Endocrine Society Corresponding author: Hye Seung Jung This is an Open Access article distributed under the terms of the Creative Com- Department of Internal Medicine, Seoul National University Hospital, Seoul mons Attribution Non-Commercial License (https://creativecommons.org/ National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribu- 03080, Korea tion, and reproduction in any medium, provided the original work is properly Tel: +82-2-2072-0240, Fax: +82-2-764-2199, Email: junghs@snu.ac.kr cited. www.e-enm.org 194 Favorable Effects of Once-Daily IDegAsp in Type 2 Diabetes Endocrinol Metab 2020;35:194-195 https://doi.org/10.3803/EnM.2020.35.1.194 pISSN 2093-596X · eISSN 2093-5978 2. Prasad-Reddy L, Isaacs D. A clinical review of GLP-1 re- ORCID ceptor agonists: efficacy and safety in diabetes and beyond. Han Na Jang https://orcid.org/0000-0002-6186-2937 Drugs Context 2015;4:212283. Hye Seung Jung https://orcid.org/0000-0002-0221-7049 3. Rosenstock J, Aronson R, Grunberger G, Hanefeld M, Piatti P, Serusclat P, et al. Benefits of lixilan, a titratable fixed-ratio combination of insulin glargine plus lixisenatide, versus in- REFERENCES sulin glargine and lixisenatide monocomponents in type 2 1. Jang HN, Yang YS, Lee SO, Oh TJ, Koo BK, Jung HS. Fa- diabetes inadequately controlled on oral agents: The Lixi- vorable glycemic control with once-daily insulin degludec/ Lan-O Randomized Trial. Diabetes Care 2016;39:2026-35. insulin aspart after changing from basal insulin in adults 4. American Diabetes Association. 9. Pharmacologic ap- with type 2 diabetes. Endocrinol Metab (Seoul) 2019;34: proaches to glycemic treatment: standards of medical care in 382-9. diabetes-2020. Diabetes Care 2020;43(Suppl 1):S98-110. Copyright © 2020 Korean Endocrine Society www.e-enm.org http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Endocrinology and Metabolism Pubmed Central

Response: Favorable Glycemic Control with Once-Daily Insulin Degludec/Insulin Aspart after Changing from Basal Insulin in Adults with Type 2 Diabetes (Endocrinol Metab 2019; 34:382-9, Han Na Jang et al.)

Endocrinology and Metabolism, Volume 35 (1) – Mar 19, 2020

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Copyright © 2020 Korean Endocrine Society
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Abstract

Endocrinol Metab 2020;35:194-195 https://doi.org/10.3803/EnM.2020.35.1.194 Response pISSN 2093-596X · eISSN 2093-5978 Favorable Glycemic Control with Once-Daily Insulin Degludec/Insulin Aspart after Changing from Basal Insulin in Adults with Type 2 Diabetes (Endocrinol Metab 2019; 34:382-9, Han Na Jang et al.) Han Na Jang, Hye Seung Jung Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Thank you so much for your interest in our paper and for your study. As you pointed out, precise measurements of the gap be- insightful comments on it. Our paper suggests that once-daily tween predicted and measured FPG should be performed in a insulin degludec/insulin aspart (IDegAsp) can control blood large cohort. glucose levels better than once-daily basal insulin, especially for As you mentioned, GLP-1 agonists are beneficial for post- patients with severe insulin deficiency and high blood glucose prandial blood glucose control and have a cardiovascular pro- variation [1]. tective effect [2], so the use of a combination of basal insulin As you pointed out, this study has the limitations of a retro- and a GLP-1 agonist can effectively control postprandial blood spective design, a small number of patients, and a short follow- glucose and obtain cardiovascular protective effects without in- up duration. Therefore, we acknowledge that the conclusions of creasing the number of injections [3]. However, there are still this study are not fully definitive; instead, we interpret the re- patients in whom it is difficult to use a GLP-1 agonist due to a sults as suggesting the need to conduct further research to iden- low glomerular filtration rate or adverse effects such as gastro- tify an indicator of the subset of patients who obtain more bene- intestinal troubles [2]. Most of all, the eventual failure of GLP-1 fits by changing from basal insulin to IDegAsp. This would be a therapy leads to multiple daily insulin injections, which would significant advance because IDegAsp has failed to demonstrate involve a mixed regimen such as IDegAsp [4]. superiority to basal insulin in the broader population of insulin- Thank you again for your comments on our paper. If you have dependent patients with diabetes. Based on this pilot study, we any other comments or questions, please feel free to contact me. are planning to perform a randomized controlled trial compar- ing IDegAsp to basal insulin in patients with a high gap between CONFLICTS OF INTEREST the predicted fasting plasma glucose (FPG) level and the mea- sured FPG. With concurrent analysis using continuous glucose No potential conflict of interest relevant to this article was re- monitors, we expect to elucidate the relationship between the ported. effects of IDegAsp and glycemic variability in this upcoming Received: 18 February 2020, Accepted: 21 February 2020 Copyright © 2020 Korean Endocrine Society Corresponding author: Hye Seung Jung This is an Open Access article distributed under the terms of the Creative Com- Department of Internal Medicine, Seoul National University Hospital, Seoul mons Attribution Non-Commercial License (https://creativecommons.org/ National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribu- 03080, Korea tion, and reproduction in any medium, provided the original work is properly Tel: +82-2-2072-0240, Fax: +82-2-764-2199, Email: junghs@snu.ac.kr cited. www.e-enm.org 194 Favorable Effects of Once-Daily IDegAsp in Type 2 Diabetes Endocrinol Metab 2020;35:194-195 https://doi.org/10.3803/EnM.2020.35.1.194 pISSN 2093-596X · eISSN 2093-5978 2. Prasad-Reddy L, Isaacs D. A clinical review of GLP-1 re- ORCID ceptor agonists: efficacy and safety in diabetes and beyond. Han Na Jang https://orcid.org/0000-0002-6186-2937 Drugs Context 2015;4:212283. Hye Seung Jung https://orcid.org/0000-0002-0221-7049 3. Rosenstock J, Aronson R, Grunberger G, Hanefeld M, Piatti P, Serusclat P, et al. Benefits of lixilan, a titratable fixed-ratio combination of insulin glargine plus lixisenatide, versus in- REFERENCES sulin glargine and lixisenatide monocomponents in type 2 1. Jang HN, Yang YS, Lee SO, Oh TJ, Koo BK, Jung HS. Fa- diabetes inadequately controlled on oral agents: The Lixi- vorable glycemic control with once-daily insulin degludec/ Lan-O Randomized Trial. Diabetes Care 2016;39:2026-35. insulin aspart after changing from basal insulin in adults 4. American Diabetes Association. 9. Pharmacologic ap- with type 2 diabetes. Endocrinol Metab (Seoul) 2019;34: proaches to glycemic treatment: standards of medical care in 382-9. diabetes-2020. Diabetes Care 2020;43(Suppl 1):S98-110. Copyright © 2020 Korean Endocrine Society www.e-enm.org

Journal

Endocrinology and MetabolismPubmed Central

Published: Mar 19, 2020

References

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