Simple Insulin-Delivery Device Helpful in Type 2 Diabetes

Miriam E Tucker

June 24, 2015

BOSTON — Use of the V-Go (Valeritas) insulin-delivery device improved glycemic control and reduced insulin requirements in adults with type 2 diabetes, new data show.

The findings were presented at the recent American Diabetes Association (ADA) 2015 Scientific Sessions by Dianne Fetchick, MD, and Rosemarie Lajara, MD, both endocrinologists with Diabetes America (Plano, Texas).

The V-Go is a small (2.4 x 1.3 x 0.5 in) disposable manual insulin-delivery device that is cleared by the US Food and Drug Administration for use in adult diabetic patients who require insulin. It attaches directly to the skin and delivers insulin via an inserted needle.

Three versions of the device deliver 20, 30, or 40 units of basal insulin evenly over 24 hours. The wearer clicks a button to deliver mealtime insulin boluses, at 2 units per click.

While V-Go might be appropriate for some patients with type 1 diabetes as an alternative to multiple daily injections, it is primarily designed for type 2 diabetes patients who are new to insulin, new to basal-bolus regimens, or who seek an alternative to multiple daily injections, Dr Lajara told Medscape Medical News.

"Adherence to multiple injections can be a barrier and poor adherence can impact glycemic control....V-Go provides a simple transition to basal-bolus therapy for patients not achieving glycemic targets with basal insulin and requiring prandial coverage, as well as for those symptomatic patients naive to insulin with high A1cs [who] can benefit early on from intensified insulin therapy vs a more gradual approach," she explained.

Francine R Kaufman, MD, vice president of global medical affairs for insulin pump and glucose sensor manufacturer Medtronic Diabetes, Northridge, California — which is not involved in the development of V-Go — told Medscape Medical News she thought this new technology had a place.

"I think it's great to have alternative, simplistic ways to deliver insulin in a basal-bolus methodology. It's good to see that intensive management of type 2 diabetes is a focus as well," she said.

Improved HbA1c, 20% Less Insulin

Researchers reported two studies at the ADA meeting; in the first, 72 patients (most of whom had type 2 diabetes) had been switched to the V-Go from either multiple daily injections (39), basal insulin only (24), or oral glucose-lowering medications (9). They had a mean age of 53 years, mean body mass index of 33 kg/m2, and 56% were female.

Retrospective analysis of their electronic health records revealed an overall statistically significant drop in HbA1c from 9.6% at baseline to 7.9% at 88 days, 7.6% at 177 days, and 7.7% at 279 days (P < .0001 compared with baseline for all three time points).

The patients who had previously been on basal insulin alone or noninsulin agents had the greatest HbA1c reductions, of 1.9 and 3.5 percentage points from baselines of 9.8% and 10.9%, respectively.

For the 63 patients who had already been taking insulin, switching to the V-Go resulted in a 20.5% reduction in total daily insulin dose from the patient-reported baseline (P < .05).

And in a separate study of 151 patients switched to V-Go, progressively greater reductions in HbA1c were seen as baseline HbA1c increased, with average percentage point drops at 6 months of 0.8 for those who started out at 7.2% to 8.9%, 1.9 for those with baseline HbA1c 9.0% to 10.4%, and 3.2 for those starting at 10.5% to 13.9%.

Simple Transition

Dr. Lajara told Medscape Medical News, "The transition is simple for those already on basal-bolus therapy, considering V-Go decreases their daily injections while improving glycemic control, utilizing less insulin due to both the efficiency of the insulin delivery and the convenience of dosing."

She added, "Clinical experience and a clear understanding of what the patient has previously administered always factors into insulin-prescribing decisions."

The V-Go basal rate can be determined using the patient's baseline weight, and the bolus dosing depends on clinical judgment, with a goal of approximately 50/50 basal/bolus. Titration can be based on the preprandial blood glucose levels captured from the patient's self-monitored blood sugars, meal size, carbohydrate intake, and/or postprandial readings.

"The convenience of on-demand bolus dosing with V-Go allows for the clinician to individualize dosing and titration based on the needs of the patient," she added.

Dr Kaufman noted that many patients with type 2 or secondary diabetes need the sophisticated features of her company's (Medtronic) more complex automated insulin pumps, such as multiple basal rates.

Nonetheless, she said, "there is a role for a simpler pump."

The study was funded by Valeritas. Dr Lajara is an advisor to and/or speaker for Boehringer Ingelheim, Novo Nordisk, Dexcom, AstraZeneca, Valeritas, Insulet, and Takeda. Dr Kaufman is an employee of Medtronic Diabetes.

American Diabetes Association 2015 Scientific Sessions; June 7, 2015; Boston, Massachusetts. Abstract 1083-P, Abstract 1091-P

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