More Similarities Than Differences Testing Insulin Glargine 300 Units/mL Versus Insulin Degludec 100 Units/mL in Insulin-Naive Type 2 Diabetes: The Randomized Head-to-Head BRIGHT Trial

Julio Rosenstock, Alice Cheng, Robert Ritzel, Zsolt Bosnyak, Christine Devisme, Anna M G Cali, Jochen Sieber, Peter Stella, Xiangling Wang, Juan P Frías, Ronan Roussel, Geremia B Bolli

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To compare insulin glargine 300 units/mL (Gla-300) versus insulin degludec 100 units/mL (IDeg-100) in this first head-to-head randomized controlled trial.

RESEARCH DESIGN AND METHODS: BRIGHT (NCT02738151) was a multicenter, open-label, active-controlled, two-arm, parallel-group, 24-week, noninferiority study in insulin-naive patients with uncontrolled type 2 diabetes. Participants were randomized 1:1 to evening dosing with Gla-300 (N = 466) or IDeg-100 (N = 463), titrated to fasting self-monitored plasma glucose of 80-100 mg/dL. The primary end point was HbA1c change from baseline to week 24. Safety end points included incidence and event rates of hypoglycemia.

RESULTS: At week 24, HbA1c improved similarly from baseline values of 8.7% (72 mmol/mol) in the Gla-300 group and 8.6% (70 mmol/mol) in the IDeg-100 group to 7.0% (53 mmol/mol)-least squares mean difference -0.05% (95% CI -0.15 to 0.05) (-0.6 mmol/mol [-1.7 to 0.6])-demonstrating noninferiority of Gla-300 versus IDeg-100 (P < 0.0001). Hypoglycemia incidence and event rates over 24 weeks were comparable with both insulins, whereas during the active titration period (0-12 weeks) the incidence and rate of anytime (24-h) confirmed hypoglycemia (≤70 and <54 mg/dL) were lower with Gla-300. Both insulins were properly titrated and exhibited no specific safety concerns.

CONCLUSIONS: Gla-300 and IDeg-100 provided similar glycemic control improvements with relatively low hypoglycemia risk. Hypoglycemia incidence and rates were comparable with both insulins during the full study period but lower in favor of Gla-300 during the titration period. The choice between these longer-acting basal insulins may be determined by factors such as access and cost, alongside clinical considerations.

Original languageEnglish
Pages (from-to)2147-2154
Number of pages8
JournalDiabetes Care
Volume41
Issue number10
DOIs
Publication statusPublished - Oct 2018
Externally publishedYes

Keywords

  • Aged
  • Blood Glucose/analysis
  • Diabetes Mellitus, Type 2/blood
  • Female
  • Glycated Hemoglobin A/analysis
  • Humans
  • Hypoglycemic Agents/administration & dosage
  • Insulin Glargine/administration & dosage
  • Insulin, Long-Acting/administration & dosage
  • Male
  • Middle Aged

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