Effect of switching medically vulnerable patients with uncontrolled diabetes from isophane insulin human to insulin glargine

Abstract

Purpose. The purpose of this observational study was to determine if switching from isophane insulin human (NPH) to insulin glargine would improve glycemic control in a medically vulnerable population with uncontrolled diabetes. Methods. A retrospective cohort review of patients' medical records was performed that recorded events occurring between January 1, 2001, and December 31, 2003. The cohort consisted of patients with diabetes in an adult medicine clinic at a county hospital. Patients were included if they were receiving NPH insulin for a minimum of six months and subsequently switched to insulin glargine for a minimum of six months. Results. The study included 43 patients. There was no significant difference in mean glycosylated hemoglobin (HbA 1c ) between NPH insulin (9.6%) and insulin glargine (9.7%) regimens (p = 0.78, 95% confidence interval, -0.62%, 0.82%). Neither was there a significant difference in the frequency or severity of hypoglycemic episodes between the two treatments. Patients experienced significantly fewer diabetesassociated visits over six months while on insulin glargine. Refill frequency did not differ significantly when patients were receiving NPH insulin versus insulin glargine. When analyzing patient characteristics, those of Hispanic ethnicity experienced HbA 1c values significantly higher than white patients. Several characteristics were associated with refill frequency. Conclusion. The results of our study indicate that both NPH-and glargine-based basal insulin regimens result in similar levels of glycemic control in a medically vulnerable population with diabetes, without significant differences in the number or severity of hypoglycemic episodes or in refill frequency.

Persistence with injectable antidiabetic agents in members with type 2 diabetes in a commercial managed care organization

“…The impact of number of insulin injections on medication adherence has been examined in one small retrospective study. Using medical records to examine basal insulin refill history in patients who used NPH insulin for a minimum of 6 months and had switched to insulin glargine for a minimum of 6 months, no statistically significant difference in the refill history between NPH and insulin glargine was found (odds ratio 1.65, 95% CI [0.78, 3.48]) 12 . The results of this study show that persistence with insulin glargine, insulin detemir, and exenatide was similar (7.6 to 7.8 months).…”

Improved glycaemic control by switching from insulin NPH to insulin glargine: a retrospective observational study

“…The data were collected from a large number of primary practice units which is likely to introduce a considerable level of heterogeneity to the main findings. As well, the level of data collection did not permit investigation of potential influences on glycaemic control including differences in racial background [ 23 ], body mass index [ 29 , 34 ], frequency of NPH and glargine use (once vs. twice daily) [ 35 ], concurrent use of OADs with glargine [ 36 ], time of administration of glargine (morning vs. bedtime) [ 37 , 38 ] and patient compliance [ 39 , 40 ]. Second, it was not possible to reliably assess data concerning hypoglycaemic episodes in patients who switch from a NPH-based regimen to a glargine-based regimen.…”

Switching from premixed insulin to glargine-based insulin regimen improves glycaemic control in patients with type 1 or type 2 diabetes: a retrospective primary care-based analysis

“…However, we do acknowledge that the level of data collection in our analysis did not permit investigation of various factors that may have influenced our findings, including certain background characteristics (e.g. ethnicity, body mass index) of the patient population [ 29 - 31 ], dosing regimen (once vs. twice daily) [ 32 ] increased patient compliance following the switch (e.g. higher number of general practice visits) and timing of administration of glargine (morning vs. bedtime) [ 33 , 34 ].…”