title: Comparison of glycemic variability in Japanese patients with type 1 diabetes receiving insulin degludec versus insulin detemir using continuous glucose monitoring: a randomized, cross-over, pilot study.
abstract: OBJECTIVE
  To use continuous glucose monitoring (CGM) to compare glycemic variability in patients with type 1 diabetes (T1D) treated with insulin degludec (IDeg) versus insulin detemir (IDet).
  
  
  METHODS
  Ten patients with T1D were randomly assigned to receive once-daily IDeg, followed by twice-daily IDet, or vice versa. Glucose variability was evaluated by CGM after >4 weeks of the first insulin and again after crossover to the second insulin.
  
  
  RESULTS
  The total daily insulin dose (U/kg/day) and the total daily basal insulin dose (U/kg/day) were significantly lower during treatment with IDeg than with IDet [median (interquartile range): 0.55 (0.54-0.73) vs. 0.64 (0.54-0.83); P = 0.028, 0.24 (0.19-0.36) vs. 0.30 (0.19-0.39); P = 0.027]. The 24-hour mean glucose levels were not significantly different. However, their standard deviation (SD) was significantly smaller during treatments with IDeg than those with IDet [59.5 (39.5-71.0) vs. 72.8 (61.8-92.8); P = 0.008]. Their mean fasting glucose levels and the mean postprandial peak levels after breakfast and after dinner were significantly lower with IDeg.
  
  
  CONCLUSIONS
  A CGM-based comparison demonstrated that once-daily IDeg showed fewer glycemic fluctuations than twice-daily IDet. IDeg appears to stabilize blood glucose levels better during both daytime and nighttime (particularly, before and after breakfast) with a lower insulin dosage.
authors.affiliation: a Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine , Jikei University School of Medicine , Tokyo , Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: a Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine , Jikei University School of Medicine , Tokyo , Japan.|b Graduate School of Public Health , University of Pittsburgh , Pittsburgh , PA , USA.
authors.forename: Rimei
authors.initials: R
authors.lastname: Nishimura
authors.affiliation: a Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine , Jikei University School of Medicine , Tokyo , Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Onda
authors.affiliation: a Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine , Jikei University School of Medicine , Tokyo , Japan.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Ando
authors.affiliation: a Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine , Jikei University School of Medicine , Tokyo , Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tsujino
authors.affiliation: a Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine , Jikei University School of Medicine , Tokyo , Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Utsunomiya
mesh_terms: D001786:Blood Glucose / Q000187:drug effects; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000069057:Insulin Detemir / Q000627:therapeutic use*; D049528:Insulin, Long-Acting / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019518:Postprandial Period
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D000069057:Insulin Detemir; C571886:insulin degludec
keywords: Clinical trial; basal-bolus insulin therapy; continuous glucose monitoring; insulin degludec; insulin detemir; type 1 diabetes