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Randomized Double-Blind Clinical Trial Comparing Ultra Rapid Lispro With Lispro in a Basal-Bolus Regimen in Patients With Type 2 Diabetes: PRONTO-T2D

OBJECTIVE: To evaluate the efficacy and safety of ultra rapid lispro (URLi) versus lispro in patients with type 2 diabetes on a basal-bolus insulin regimen. RESEARCH DESIGN AND METHODS: This was a phase 3, treat-to-target, double-blind 26-week study. After an 8-week lead-in to optimize basal insulin...

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Detalles Bibliográficos
Autores principales: Blevins, Thomas, Zhang, Qianyi, Frias, Juan P., Jinnouchi, Hideaki, Chang, Annette M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Diabetes Association 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7770265/
https://www.ncbi.nlm.nih.gov/pubmed/32616612
http://dx.doi.org/10.2337/dc19-2550
Descripción
Sumario:OBJECTIVE: To evaluate the efficacy and safety of ultra rapid lispro (URLi) versus lispro in patients with type 2 diabetes on a basal-bolus insulin regimen. RESEARCH DESIGN AND METHODS: This was a phase 3, treat-to-target, double-blind 26-week study. After an 8-week lead-in to optimize basal insulin glargine or degludec in combination with prandial lispro treatment, patients were randomized to blinded URLi (n = 336) or lispro (n = 337) injected 0–2 min prior to meals. Patients could continue metformin and/or a sodium–glucose cotransporter 2 inhibitor. The primary end point was change in HbA(1c) from baseline to 26 weeks (noninferiority margin 0.4%), with multiplicity-adjusted objectives for postprandial glucose (PPG) excursions during a standardized meal test. RESULTS: HbA(1c) improved for both URLi and lispro, and noninferiority was confirmed: estimated treatment difference (ETD) 0.06% (95% CI −0.05; 0.16). Mean change in HbA(1c) was −0.38% for URLi and −0.43% for lispro, with an end-of-treatment HbA(1c) of 6.92% and 6.86%, respectively. URLi was superior to lispro in controlling 1- and 2-h PPG excursions: 1-h ETD, −0.66 mmol/L (95% CI −1.01, −0.30); 2-h ETD, −0.96 mmol/L (−1.41, −0.52). Significantly lower PPG excursions were evident from 0.5 to 4.0 h postmeal with URLi treatment. There were no significant treatment differences in rates of severe or documented hypoglycemia (<3.0 mmol/L). Incidence of overall treatment-emergent adverse events was similar between treatments. CONCLUSIONS: URLi compared with lispro in a basal-bolus regimen was confirmed to be noninferior for HbA(1c) and superior to lispro for PPG control in patients with type 2 diabetes.