Insulin Glargine Combined with Oral Antidiabetic Drugs for Asians with Type 2 Diabetes Mellitus: A Pooled Analysis to Identify Predictors of Dose and Treatment Response

Abstract

IntroductionIn Asia, patients with type 2 diabetes mellitus (T2DM) often have suboptimal glycemic control for many years prior to initiating basal insulin. Active titration of basal insulin is also required to improve glycemic outcomes. This pooled analysis was conducted to determine the impact of patient baseline covariates on the required dose of basal insulin and treatment response, for the improved management of Asian patients with T2DM.MethodsData on insulin-naïve Asian patients with T2DM who initiated and fully titrated insulin glargine 100 U/mL (Gla-100) for ≥ 20 weeks were pooled from seven randomized, controlled, treat-to-target trials. Covariance and multivariate linear/logistic regression analyses were applied to determine the impact of the baseline covariates on Gla-100 dose (primary outcome) and treatment response (secondary outcomes) at week 24 for patients from Asia (N = 724) and from China alone (n = 249). Based on the multivariate analysis for the primary outcome in the Asian population, a nomogram was developed.ResultsThe dose of Gla-100 at week 24 was negatively correlated with age and positively correlated with body mass index (BMI) and fasting plasma glucose (FPG) at baseline in both Asian and Chinese populations. In both populations, higher baseline glycated hemoglobin (HbA1c) was associated with a lower reduction in HbA1c from baseline, higher HbA1c at week 24, and a lower chance of achieving HbA1c < 7% at week 24. The constructed nomogram enables calculation of the likely dose of Gla-100 required by Asian patients with T2DM to achieve HbA1c < 7% at week 24.ConclusionsHigher doses of Gla-100 are likely to be required in younger patients or patients with higher baseline BMI or FPG. The nomogram developed in this study can aid clinicians to titrate the dose of Gla-100 appropriately. Evidence in this pooled analysis also indicates that initiating basal insulin at a lower HbA1c can lead to greater glycemic control.FundingSanofi China Investment Company.Electronic supplementary materialThe online version of this article (10.1007/s13300-018-0381-9) contains supplementary material, which is available to authorized users.

Patient characteristics and 6‐month dose of basal insulin associated with HbA1c achievement <7.0% in Chinese people with type 2 diabetes: results from the Observational Registry of Basal Insulin Treatment (ORBIT)

“…The pooled analysis showed that higher doses of glargine are likely to be required in patients with higher baseline BMI or FPG in both Asian and Chinese populations. 17 The Asian Treat to Target Lantus Study(ATLAS) is designed to compare the effectiveness of a patient's-versus physician's-led titration of insulin glargine-based basal insulin management in the specific setting of Asia. A total of 161 Chinese patients were randomized 1:1 to the above two groups.…”

Lilly Insulin Glargine Versus Lantus® in Insulin-Naïve and Insulin-Treated Adults with Type 2 Diabetes: A Randomized, Controlled Trial (ELEMENT 5)

“…Because of interethnic differences in the pathophysiology of T2D and its high prevalence in Asian populations, it is important to study the effects of antihyperglycemic therapies in Asian patients. Three recent publications have reviewed and/or analyzed previously reported IGlar treatment results in Asian patients from multiple RCTs or from a combination of RCTs and real-world data [ 42 – 44 ]. These studies suggest the need for timely initiation of basal insulin [ 42 , 44 ] or a combination of basal insulin/prandial therapy (i.e., incretin mimetics or rapid-acting insulin) [ 43 ] in Asian patients with T2D.…”

Cost comparisons of available brands of insulin glargine preparations

“…3 Insulin glargine belonging to the insulin group of drugs, is one of the important baseline insulin sub types used in IDDM (insulin dependent diabetes mellitus), certain select cases of NIDDM (non-insulin dependent diabetes mellitus) and certain specific clinical situations in diabetes management. 4,5 It is used as a baseline insulin preparation which covers the daily baseline requirement of insulin in the patient. It is used along with bolus insulin preparations or oral drugs.…”