Nasal glucagon was efficacious in reversing insulin-induced hypoglycaemia without increasing risk of secondary hyperglycaemia

Background and Aims Nasal glucagon (NG) contains 3-mg glucagon dry powder absorbed passively through nasal mucosa. We evaluated efficacy, pharmacodynamics, and safety of NG compared to injectable-glucagon (IG) in reversing insulin-induced hypoglycaemia in adults with T1D or T2D. Methods: Data from 2 randomised, cross-over studies was analysed. Treatment success was defined as increase in blood glucose to ≥3.9mmol/L or increase of ≥1.1mmol/L from nadir blood glucose within 15 minutes of receiving glucagon. Pharmacodynamic data, including area under the curve above 7.8mmol/L (∆7.8AUC [1-4hr]), evaluated risk of secondary hyperglycaemia. Tolerability was assessed with treatment-emergent adverse events and a nasal symptom questionnaire. Results: A similar proportion of NG (97.8% [131/134)] and IG patients (97.0% [130/134]) achieved treatment success, with mean time 11.7 and 10.4 minutes, (p< 0.001) respectively. Median time for both was 10 minutes. Geometric least square mean maximal blood glucose (BGmax) for NG and IG were 10.8 and 11.4 mmol/L (p < 0.001), respectively. NG had significantly lower ∆7.8AUC (1-4hr) (p< 0.001), with 42% reduction compared to IG. NG had similar rates of nausea (19.1%) and vomiting (8.5%) versus IG (28.8% and 11.5%, respectively), with higher rates of side effects related to nasal administration (headache [7.8% NG, 5.8% IG], upper respiratory tract irritation [6.4% NG, 0.7% IG]). Separate T1D and T2D analyses showed similar results as T1D and T2D groups combined. Conclusion: NG was efficacious and well tolerated in reversing insulin-induced hypoglycaemia in adults with T1D or T2D and did not increase the risk of secondary hyperglycaemia compared to IG.

Interessenskonflikt

YY, QW, CC, MZ are employees and stockholders of Eli Lilly and Company.

Elisabeth Moennig is employee of Lilly Deutschland GmbH and stockholder of the company.

Publikationsverlauf

Artikel online veröffentlicht:
06. Mai 2021