Insulin degludec, an ultra-longacting basal insulin, versus insulin glargine in basal-bolus treatment with mealtime insulin aspart in type 2 diabetes (BEGIN Basal-Bolus Type 2): a phase 3, randomised, open-label, treat-to-target non-inferiority trial

  title={Insulin degludec, an ultra-longacting basal insulin, versus insulin glargine in basal-bolus treatment with mealtime insulin aspart in type 2 diabetes (BEGIN Basal-Bolus Type 2): a phase 3, randomised, open-label, treat-to-target non-inferiority trial},
  author={Alan J. Garber and Allen B King and Stefano del Prato and S{\'e}amus Sreenan and Mustafa Kemal Balci and Manuel Mu{\~n}oz-Torres and Julio Rosenstock and Lars A. Endahl and A. M. Ocampo Francisco and Priscilla A. Hollander},
  journal={The Lancet},

Figures and Tables from this paper

Reduced risk of hypoglycemia with insulin degludec versus insulin glargine in patients with type 2 diabetes requiring high doses of basal insulin: a meta-analysis of 5 randomized begin trials.

In this post hoc meta-analysis, more than 30% of subjects with T2D required >60 U/day of basal insulin at the end of the trials and IDeg achieves similar HbA1c reduction with significantly less overall and nocturnal confirmed hypoglycemia compared with IGlar.

Insulin Degludec Versus Insulin Glargine in Type 1 and Type 2 Diabetes Mellitus: A Meta-Analysis of Endpoints in Phase 3a Trials

Compared with glargine, degludec is associated with equivalent HbA1c control and significantly lower nocturnal hypoglycemia rates and is also associated with significantly greater reductions in FPG and lower total doses of insulin versus glargines in T1DMB/B and T2DMinsulin-naïve.

Insulin degludec improves long‐term glycaemic control similarly to insulin glargine but with fewer hypoglycaemic episodes in patients with advanced type 2 diabetes on basal‐bolus insulin therapy

During 18 months of treatment, insulin degludec + mealtime insulin aspart ± oral antidiabetic drugs in patients with T2D improves glycaemic control similarly, but confers lower risks of overall and nocturnal hypoglycaemia than with insulin glargine treatment.

Insulin Degludec Versus Insulin Glargine in Insulin-Naive Patients With Type 2 Diabetes

Insulins degludec and glargine administered once daily in combination with OADs provided similar long-term glycemic control in insulin-naive patients with type 2 diabetes, with lower rates of nocturnal hypoglycemia with deglUDec.

A Multinational, Randomized, Open-label, Treat-to-Target Trial Comparing Insulin Degludec and Insulin Glargine in Insulin-Naïve Patients with Type 2 Diabetes Mellitus

IDeg provided adequate glycemic control non-inferior to IGlar and a tendency for a lower hypoglycemia rate and is considered suitable for initiating insulin therapy in T2DM patients on OADs requiring intensified treatment.

Effect of Insulin Degludec vs Insulin Glargine U100 on Hypoglycemia in Patients With Type 2 Diabetes: The SWITCH 2 Randomized Clinical Trial

To test whether treatment with basal insulin degludec is associated with a lower rate of hypoglycemia compared with insulin glargine U100 in patients with type 2 diabetes, a Randomized, double-blind, treat-to-target crossover trial was conducted.

Treating to target in type 2 diabetes: the BEGIN trial programme.

In clinical trials, insulin degludec achieved similar glycaemic control to that seen with insulin glargine in patients with type 1 or 2 diabetes, but with a lower risk of nocturnal hypoglycaemia.

Basal and Bolus Insulin Dose Changes after Switching Basal Insulin to Insulin Degludec in Patients with Type 1 Diabetes Mellitus: A Pilot Study

DEG improved glycemic control when switched from once-daily BI and maintained gly glucose control when switch from twice- daily BI without increasing hypoglycemia.

Efficacy and safety of insulin degludec U100 and insulin glargine U100 in combination with meal-time bolus insulin in hospitalized patients with type 2 diabetes: an open-label, randomized controlled study.

It is suggested that short-term efficacy and safety of IDeg and IGla in patients with type 2 diabetes during the initial phase of basal-bolus therapy were comparable, and these results can help in deciding which treatment to opt for.



The treat-to-target trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients.

Systematically titrating bedtime basal insulin added to oral therapy can safely achieve 7% HbA(1c) in a majority of overweight patients with type 2 diabetes, thus reducing a leading barrier to initiating insulin.

Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group.

The proportion of patients who maintained target glycemic levels declined markedly over 9 years of follow-up, and the progressive deterioration of diabetes control was such that after 3 years approximately 50% of patients could attain this goal with monotherapy, and by 9 years this declined to approximately 25%.

Insulin detemir versus insulin glargine for type 2 diabetes mellitus.

There is no clinically relevant difference in efficacy or safety between insulin detemir and insulin glargine for targeting hyperglycaemia and only one trial reported results on health-related quality of life and showed no significant differences between treatment groups.

Insulin degludec has a two-fold longer half-life and a more consistent pharmacokinetic profile compared with insulin glargine

IDeg has a half-life that is twice as long as IGlar with a more evenly distributed and stable pharmacokinetic exposure and glucose-lowering effect, over 24 hours at steady state in patients with T1D.

Efficacy of Bedtime NPH Insulin With Daytime Sulfonylurea for Subpopulation of Type II Diabetic Subjects

The results suggest this simple regimen offers another option, besides multiple injections of insulin, for patients of this kind who are unsuccessful with a sulfonylurea or a single injection of insulin alone, under conditions similar to those of clinical practice.

Hypoglycemia as a barrier to glycemic control.

Hypoglycaemia: The limiting factor in the glycaemic management of Type I and Type II Diabetes*

  • P. Cryer
  • Medicine, Biology
  • 2002
Perhaps the most compelling support for HAAF is the finding that as little as 2 to 3 weeks of scrupulous avoidance of hypoglycaemia reverses hypoglyCAemia unawareness and improves the reduced epinephrine component of defective glucose counterregulation in most affected patients.

The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study

Symptomatic, severe hypoglycaemia was associated with an increased risk of death within each study arm, however, among participants who experienced at least one episode of hypglycaemia, the risk ofdeath was lower in such participants in the intensive arm than in the standard arm.

Type 2 Diabetes Care and Insulin Intensification

PCPs are less involved in the initiation and intensification of insulin than specialists; however, all physicians appreciate the need for increased PCP involvement and a multidisciplinary approach that includes using the skills of diabetes educators will assist physicians in improving management of T2D.