There was no statistically significant difference in the proportion of those experiencing severe hypoglycaemia with insulin degludec vs insulin glargine U100 (1.6% of patients vs 2.4 %, p=0.35).
A related study in people with type 1 diabetes (SWITCH 1) found a statistically significant reduction in hypoglycaemia, nocturnal hypoglycaemia and symptomatic hypoglycaemia for insulin degludec compared to insulin glargine U100.
A related editorial comments on these studies. Currently, it is common practice to manage hypoglycaemia by increasing the haemoglobin A1c target and deintensifying the glycaemic treatment program. The appropriateness of this approach, however, has recently been challenged. It comments on strengths and limitations (e.g. high dropout rate and definition of hypoglycaemia) of this new evidence, and that caveats need to be considered. These insulin types were titrated using a set protocol that probably exceeds common clinical practice, so cautious clinicians may want to see the results of a more pragmatic trial. Also results may not be generalizable to insulin glargine U300 or other alternative basal insulins. Despite these concerns, the SWITCH 1 and SWITCH 2 studies show that insulin degludec has lower rates of hypoglycaemia than insulin glargine U100. Given the risks associated with hypoglycaemia and the negative consequences that concerns about hypoglycaemia have for patients and their families, any basal insulin associated with a reduced rate of hypoglycaemia would seem to represent an advance in therapy.