Insulin glargine-based therapy improves glycemic control in patients with type 2 diabetes sub-optimally controlled on premixed insulin therapies

• Published in: Diabetes research and clinical practice Vol. 79; no. 2; pp. 368 - 375
• Main Authors: Davies, Melanie, Sinnassamy, Patrick, Storms, Fred, Gomis, Ramon
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.02.2008
• Subjects: Aged; Algorithms; Basal insulin analogs; Blood Glucose - drug effects; Blood Glucose - metabolism; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Drug Administration Schedule; Drug Therapy, Combination; Endocrinology & Metabolism; Female; Glycated Hemoglobin A - metabolism; Humans; Hypoglycemia - chemically induced; Hypoglycemia - prevention & control; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Insulin - adverse effects; Insulin - analogs & derivatives; Insulin - therapeutic use; Insulin Glargine; Insulin, Long-Acting; Male; Middle Aged; Premixed insulin; Titration; Treatment algorithms; Type 2 diabetes; Type 2 diabetes; Titration; Insulin glargine; Premixed insulin; Basal insulin analogs; Treatment algorithms
• ISSN: 0168-8227; 1872-8227; 1872-8227
• DOI: 10.1016/j.diabres.2007.09.013

The AT.LANTUS trial recently demonstrated the efficacy and safety of insulin glargine initiation and maintenance using two different treatment algorithms in poorly controlled type 2 diabetes mellitus (T2DM). This sub-analysis investigated glycemic control and safety in 686 patients switching from premixed insulin (premix) with or without (±OADs) to once-daily glargine (±OADs/prandial insulin). A 24-week, multinational ( n = 59), multicenter ( n = 611), randomized study comparing two algorithms (Algorithm 1: clinic-driven titration; Algorithm 2: patient-driven titration) in four glargine ± OADs treatment groups: alone, once- (OD), twice- (BD) or >twice- (>BD) daily prandial insulin. After switching to the glargine regimen, HbA 1c levels significantly improved in the overall group (9.0 ± 1.3 to 8.0 ± 1.2%; p < 0.001) and in all subgroups; fasting blood glucose levels also improved in all subgroups (overall: 167.1 ± 50.0 to 106.9 ± 27.2 mg/dL [9.3 ± 2.8 to 5.9 ± 1.5 mmol/L]; p < 0.001). The incidence of severe hypoglycemia was also low in all four subgroups (≤1.7%). Patients with T2DM switching from premix ± OADs to glargine ± OADs had significant reductions in glycemic control with a low incidence of severe hypoglycemia. The addition of prandial (OD, BD or >BD) insulin was associated with further improvements in glycemic control. These data provide support for the stepwise introduction of prandial insulin to a more physiologic basal–bolus regimen, which is under investigation.