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Published on 3 October 2012

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Health outcomes data for basal insulin analogue

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Eli Lilly and Company (NYSE: LLY) and Boehringer Ingelheim today announced patient-reported health outcomes data from a Phase II study of their investigational novel basal insulin analogue, LY2605541, in patients with type 2 diabetes.
Study results showed that in addition to clinical results showing a statistically significant 48% baseline adjusted reduction in nocturnal hypoglycaemia compared with insulin glargine [0.25 versus 0.39 events/ 30 days/patient, after adjusting for baseline hypoglycaemia events (p=0.020)],(1) patients treated with LY2605541* reported a statistically significant reduction in the anxiety and fear associated with experiencing a hypoglycaemic event based upon the Adult Low Blood Sugar Survey (ALBSS).(2) These data will be presented at the 48th European Association for the Study of Diabetes (EASD) Annual Meeting in Berlin, Germany.
Hypoglycaemia data were collected during a Phase II clinical study comparing LY2605541with insulin glargine in patients with type 2 diabetes. In addition to the reduction in nocturnal hypoglycaemia in LY2605541-treated patients, results showed the treatments had similar overall rates of hypoglycaemia (p=0.08, not statistically significant).(1)
The study used a validated patient-experience questionnaire called the Adult Low Blood Sugar Survey (ALBSS)(3) to measure patients’ fear of mild-to-moderate hypoglycaemia and associated behaviours during the previous four weeks. Hypoglycaemia was defined as low blood glucose levels that were less than or equal to 70mg/dL. The ALBSS measures the worry or fear associated with the impact of the patients’ experience with a hypoglycaemic event and subsequent behaviours that are associated with avoiding future events based upon a previous experience.
 
The results of this study found:
Patients treated with LY2605541 had a lower average score on the fear subscale of the ALBSS at week 12 than those treated with insulin glargine (6.6 versus 10.0; p=0.022).(2)
LY2605541 and insulin glargine had similar effects on patient behaviour at week 12 (p=NS).(2) Examples of change in subsequent behaviours associated with avoiding future hypoglycaemic events included eating large snacks, keeping blood sugar levels higher in social situations, staying at home more than liked and limiting exercise/physical activity.
LY2605541-treated patients had lower average total scores on the ALBSS compared with glargine-treated patients (13.0 versus 16.5 in the glargine group; p=0.026).(2)
“As we continue development of our investigational novel basal insulin, we wanted to understand both the impact of the fear of hypoglycaemia and the impact of hypoglycaemic events and the emotional toll for the person with diabetes,” said David Kendall, MD, distinguished medical fellow, Lilly Diabetes. “We look forward to further studying LY2605541 in a large Phase III program to better understand the clinical impact of these patient-reported health outcomes results.”
About the Phase II Study(1)
The Phase II, randomised, open-label, parallel study evaluated LY2605541 in lowering self-monitored fasting blood glucose levels compared to insulin glargine in adults with type 2 diabetes. Patients were converted to morning insulin administration during a four-week lead-in period and were randomised 2:1 to morning administration of LY2605541 (195 patients) or glargine (93 patients) for a total of 12 weeks.
The primary endpoint of the study showed that LY2605541 and glargine had similar effects on lowering average daily self-monitored fasting (before breakfast) glucose levels (p=0 .433) and HbA1c (p=0.279) over 12 weeks.
Following treatment with LY2605541, blood tests on liver function (as measured by mean ALT and AST levels) statistically significantly increased from baseline and were higher than with insulin glargine. The mean levels of both liver enzymes remained within the normal range during the study for glargine and LY2605541-treated patients.
In the Phase II type 2 diabetes study, triglyceride levels in patients treated with LY2605541 were not significantly different from baseline (163 mg/dL to 172 mg/dL), but statistically higher compared to insulin glargine (160 mg/dL versus 147 mg/dL). There was no significant difference in LDL-C or HDL-C in patients treated with LY2605541 from baseline or compared with insulin glargine.
Patients also completed the Adult Low Blood Sugar Survey (ALBSS), a 33-item questionnaire divided into two subscales that independently assess patients’ behaviours related to preventing hypoglycaemia and its effects, and well as patients’ fear (worry) about consequences of a hypoglycaemic episode. This was a prospective measure in the Phase II type 2 diabetes study for LY2605541.* For each item, patients reported how often the item was true using a 5-point Likert scale (0, never to 4, almost always). Patients completed the ALBSS at baseline, week 6 and week 12 of the study. The ALBSS yields an individual score for the behavior and fear subscales as well as a total score.(2)
*LY2605541 is an investigational agent. Its efficacy and safety have not been finally established.
References
  1. Bergenstal RM, Rosenstock J, Arakaki RF, Prince MJ, Qu Y, Sinha VP, Howey DC, Jacober SJ. Weight loss and lower nocturnal hypoglycaemia with novel long-acting basal insulin LY2605541 versus insulin glargine in patients with type 2 diabetes. EASD: 48th Annual Meeting; Berlin, Germany; 2012.
  2. Curtis, B, Shi, C. Novel long-acting basal insulin analogue LY2605541 significantly reduces nocturnal hypoglycaemia and fear of hypoglycaemia compared to insulin glargine in patients with type 2 diabetes mellitus. Abstract #954. Presented at the 48th European Society for the Study of Diabetes (EASD) Annual Meeting. 1-5 October 2012, Berlin, Germany.
  3. Cox DJ, Irvine A, Gonder-Frederick L, Nowacek G, Butterfield J. Fear of hypoglycemia: quantification, validation, and utilization. Diabetes Care 1987, 10:617-621.


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