Glargine versus NPH insulin: Efficacy in comparison with insulin aspart in a basal bolus regimen in type 1 diabetes—The glargine and aspart study (GLASS)

Chatterjee, Sumana; Jarvis-Kay, J.; Rengarajan, T.; Lawrence, Ian; McNally, PG; Davies, Melanie J.

doi:10.1016/j.diabres.2006.11.002

Cited by 45 publications

(36 citation statements)

References 22 publications

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“…The fact that HbA1c levels were not even more dramatically improved may be related to lack of application of a strict treat-to-target algorithm, as in contrast to those in the RCT,13,14 and that the T1DM patients included in this analysis probably are not representative for all patients with T1DM (ie, due to the inclusion criterion), hence their diabetes is possibly more difficult to manage. Predictors for HbA1c improvements were high HbA1c and a positive insulin dosage titration.…”

Section: Discussionmentioning

confidence: 94%

“…In randomized controlled trials (RCT) comparing these insulin analogs with NPH insulin, insulin glargine and detemir demonstrated similar reductions in HbA1c and fasting plasma glucose compared to NPH insulin. Further, the use of these long-acting analogs has also been associated with fewer hypoglycemic episodes, particularly nocturnal hypoglycemia, and has also been associated with less weight gain (especially for detemir) than NPH insulin 5,11,12,13,14…”

Section: Introductionmentioning

confidence: 99%

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Changing basal insulin from NPH to detemir or glargine in patients with type 1 diabetes and a history of severe hypoglycemia

Johansen

Vanberg²,

Kilhovd³

et al. 2008

VHRM

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Background:The insulin analogs, glargine and detemir, are associated with reduced hypoglycemia incidence compared with NPH insulin. We assessed the impact of changing basal insulin from NPH to glargine or detemir in patients with type 1 diabetes mellitus who experienced severe hypoglycemia. Material and methods: A retrospective chart review was conducted that included 73 (31 female) patients (mean age 48 years, diabetes duration 19 years) treated for 12 to 24 months with insulin glargine (n = 43) or detemir (n = 30). Results: There were no patients who withdrew from treatment due to side effects. The mean treatment duration in both groups was 18 months. Changing from NPH insulin was associated with a −0.3% (p = 0.036) reduction in HbA1c for glargine (baseline 8.8%) and −0.4% (p = 0.040) for detemir (baseline 8.3%) treated patients; insulin dosages increased, respectively by 4.1 (p = 0.045) and 4.3 units (p = 0.004) (mean values). Weight did not increase signifi cantly and the 1-year rate of serious hypoglycemia was 0.25/person/year. Conclusion: Switching from NPH-insulin to insulin detemir or glargine in type 1 diabetes mellitus patients with previous serious hypoglycemia was associated with a reduction in HbA1c. However, severe hypoglycemia was not completely eliminated, and few patients reached internationally accepted glycemic treatment goals. Literature search: We searched Medline, PubMed (with key search terms type 1 diabetes, NPH insulin, detemir, glargine and serious hypoglycemia), reference lists and databases of ongoing and completed trials (through July 2008) provided from the manufacturers of the drugs to identify relevant literature. Keywords: type 1 diabetes mellitus, insulin, observational study, HbA1c, effi cacy IntroductionNeutral protamine Hagedorn (NPH) insulin is the most widely used basal insulin worldwide.1 However, NPH insulin may not be the optimal basal insulin due to its signifi cant day-to-day variability, bell-shaped effect curve and estimated 12-to 15-hour duration of action. 2,3 In addition, being a suspension of crystals, it needs proper re-suspension, a fact that is often disregarded by patients. 4 These characteristics of NPH-insulin render patients more prone to hypoglycemia and usually require the users to be on a twice daily injection schedule to attain 24-hour basal insulin coverage.3 NPH insulin is also associated with weight gain, 5 thus further reducing potential compliance. 6These are all factors that are barriers for achieving good glycemic control. These shortcomings of NPH insulin spurred the development of other basal insulin formulations, of which two are currently marketed: insulin glargine (Lantus ®; Sanofi Aventis, France); and insulin detemir (Levemir 122Johansen et al acylated with a fatty-acid chain (myristic acid) to the lysine at residue B29 of the insulin molecule which mediates albumin binding in the interstitial fl uid and plasma. 2,8,9 Both come in a clear solution and do not require re-suspension.Although none of the basal insulin analogs have a complete...

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Changing basal insulin from NPH to detemir or glargine in patients with type 1 diabetes and a history of severe hypoglycemia

Johansen

Vanberg²,

Kilhovd³

et al. 2008

VHRM

View full text Add to dashboard Cite

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“…However, treatment satisfaction and psychologic wellbeing were also evaluated in these patients (Witthaus et al 2001) and showed that insulin glargine has an advantage with respect to psychologic outcomes, as people are apparently more satisfied with treatment with insulin glargine compared with NPH insulin. Improved patient satisfaction was recently confirmed in a 36-week crossover trial (a 4-week run-in followed by 16 weeks of each active treatment) comparing insulin glargine plus insulin aspart with NPH insulin plus insulin aspart in 60 type 1 diabetic patients (Chaterjee et al 2007). …”

Section: Clinical Efficacy Of Insulin Glarginementioning

confidence: 94%

Insulin glargine in the management of diabetes mellitus: an evidence-based assessment of its clinical efficacy and economic value

Clissold

Clissold²

2007

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Introduction:Diabetes is a chronic disease associated with high morbidity and mortality, which represents a major public health concern. Interventions that can enhance patient care and reduce clinic visits will not only relieve some of this burden, they will also improve patient QOL and wellbeing.Aims:This review assesses the evidence for the use of insulin glargine in type 1 and type 2 diabetes mellitus.Evidence review:Once-daily insulin glargine has a prolonged, peakless activity profile, making it a candidate as a long-acting (basal) insulin. In combination with bolus insulin to cover prandial glucose surges, it facilitates a more physiologic approach to patient management. Evidence from large, randomized, controlled clinical trials in patients with type 1 diabetes has confirmed its effectiveness and tolerability relative to neutral protamine hagedorn (NPH) insulin, with a tendency toward causing less hypoglycemia. In patients with type 2 diabetes requiring insulin therapy, once-daily insulin glargine has proven to be clinically superior to NPH insulin in terms of providing at least as effective glycemic control, but with significantly fewer episodes of nocturnal hypoglycemia. A variety of economic analyses have confirmed the cost effectiveness of insulin glargine in type 1 and type 2 diabetes and in particular it was shown to be significantly superior to NPH insulin.Clinical value:Insulin glargine has established itself as a first-line choice in patients with type 1 diabetes, including children (>6 years) and adolescents, and is a recommended treatment option. In patients with type 2 diabetes it is clearly associated with less hypoglycemia than NPH insulin, and this may help overcome one of the major barriers to starting insulin therapy in this class of patient. Thus, insulin glargine is a valuable addition to the therapeutic armamentarium available to physicians and it has the potential to significantly improve the quality of life of patients with diabetes.

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“…Insulin glargine is a basal insulin with a duration of action of 20-24 h and a flatter effect curve than NPH insulin [5,6]. Several studies have evaluated the mean effect on HbA1c of insulin glargine compared with NPH insulin, but the results have been contradictory [7][8][9][10][11][12][13][14][15][16][17][18][19]. To the best of our knowledge, no studies have addressed any concept to study responders and non-responders for insulin glargine or any other types of insulins.…”

Section: Introductionmentioning

confidence: 91%

A method to predict the metabolic effects of changes in insulin treatment in subgroups of a large population based patient cohort

et al. 2007

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This case-control study was designed to analyse predictors of the effects on HbA1c levels in 4001 type 1 and type 2 diabetic patients after changing their insulin treatment. Patients from 15 outpatient diabetic clinics were treated with basal insulin and multiple injections of short-acting insulin. The effects on HbA1c of changing from NPH insulin to insulin glargine as basal insulin were studied, compared to patients continuing with NPH insulin. The following possible predictors were examined with multiple regression analysis: age, sex, type and duration of diabetes, smoking, metformin use, insulin requirement, number of basal doses per day, BMI and HbA1c at baseline. The difference between the two regression functions yielded the effect of switching treatment to insulin glargine compared to continuing with NPH insulin. Male gender, low BMI and high baseline HbA1c levels were significant predictors for a greater decrease in HbA1c when changing to insulin glargine. For example, for men with a BMI of 25 and an HbA1c of 8.0%, there was a calculated mean benefit in HbA1c of 0.26 percentage points by changing to insulin glargine, whereas women with a BMI 30 had no benefit of such a change. Thus, changing to insulin glargine had best effect in male patients with low BMI. This is one of the first studies designed to find responders to insulin treatment. Analyses of predictors may prove useful in order to tailor insulin treatment in diabetic patients in clinical practice. The clinical effects need to be confirmed in other studies and randomised controlled trials.

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Glargine versus NPH insulin: Efficacy in comparison with insulin aspart in a basal bolus regimen in type 1 diabetes—The glargine and aspart study (GLASS)

Cited by 45 publications

References 22 publications

Changing basal insulin from NPH to detemir or glargine in patients with type 1 diabetes and a history of severe hypoglycemia

Changing basal insulin from NPH to detemir or glargine in patients with type 1 diabetes and a history of severe hypoglycemia

Insulin glargine in the management of diabetes mellitus: an evidence-based assessment of its clinical efficacy and economic value

A method to predict the metabolic effects of changes in insulin treatment in subgroups of a large population based patient cohort

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