LAUSR

After DCCT, intensive multiple daily insulin injections protocol became the standard therapy for patients with T1DM intended to maintain a lower HbA1c without hypoglycemia and thus to decrease the risk of microvascular complications. Design and production of new basal insulin analogs with lower risk of hypoglycemia was the next challenge. The switch from NPH to the basal insulin analog Glargine represented a major clinical advantage allowing to obtain a better and safer glucose control. Degludec is a new basal insulin analog with longer half-life and lower variability than Glargine [1]. Despite these differences, clinical trials comparing Glargine and Degludec in patients with T1DM and T2DM have failed to show a clear clinical advantage of Degludec in both efficacy and safety. A statistically significant lower number of hypoglycemic events, associated with Degludec versus Glargine, have been shown only in patients at high risk of hypoglycemia and intensively treated (HbA1c < 7%), an uncommon scenario. The clinical meaning of these trials is flawed also by the small number of hypoglycemic events, often self-reported by patients. It should be noted that some patients reported hypoglycemia more than once [2–5]. Few trials have utilized CGM to detect differences between Glargine and Degludec, again results were not informative since Degludec was compared to patients treated either with Glargine or Detemir [1, 4, 5]. Together, these observations suggest that Degludec might be advantageous in Patients with high risk of hypoglycemia. Since Glargine retail price is significantly lower than that of Degludec, it is important to identify those subjects that more likely might have an advantage from switch to Degludec. Aim of this real-life study was to compare by CGM, in stable patients with T1DM, glucose variability, and time spent in hypoor hyperglycemia registered for prolonged length of time, before and after switching from Glargine to Degludec.