Insulin glargine or NPH combined with metformin in type 2 diabetes: the LANMET study

Abstract

Good glycaemic control can be achieved with both G+MET and NPH+MET. Use of G+MET reduces symptomatic hypoglycaemia during the first 12 weeks and dinner time hyperglycaemia compared with NPH+MET.

Comment on: Nauck MA, Duran S, Kim D et al (2007) A comparison of twice-daily exenatide and biphasic insulin aspart in patients with type 2 diabetes who were suboptimally controlled with sulfonylurea and metformin: a non-inferiority study. Diabetologia 50:259–267

“…In this study, insulin dose adjustment was simply left to the investigator. It is not clear from the paper what intensity of follow-up, selfmonitoring, or dose adjustment to what target occurred, but at 52 weeks the premix insulin dose was only 24 U/day, well below doses used in recent studies [4][5][6][7][8], and below doses normally encountered in clinical practice. This appeared not to be the result of hypoglycaemia in this particular group of patients-the reported hypoglycaemia rate was as low with insulin as with the glucagon-like peptide-1 mimetic.…”

“…The result of this is that the blood glucose control achieved was relatively poor in the insulin-treated group (a fall of 0.9% in HbA 1c from a baseline of 8.6%) when compared with nearly all recently published treat-to-target studies with insulin therapy in people with type 2 diabetes [4][5][6][7][8]. In these, final HbA 1c is typically <7.0% (achieved by 68% of participants in the INITIATE study [5], and eventually by 77% of participants in the 1-2-3 study, where a third premix injection was an option) [6].…”

“…In these, final HbA 1c is typically <7.0% (achieved by 68% of participants in the INITIATE study [5], and eventually by 77% of participants in the 1-2-3 study, where a third premix injection was an option) [6]. The LanMet study achieved an HbA 1c of 7.1%, but this was from baseline levels of 9.1% [8].…”

Diabetes mellitus, hyperglycaemia and cancer

“…If identical glycaemic control had been obtained in the treatment groups, with a lower dose in insulin glargine users, adjustment for insulin dose would not have been appropriate. However, three randomized clinical trials in which insulin glargine and NPH insulin were uptitrated to reach identical glycaemic targets have shown that similar doses of insulin glargine were needed as for human insulin [56][57][58]. Therefore, the hypothesis of over-adjustment can be ruled out, and it can be deduced that poorer glycaemic control was achieved in the insulin glargine-treated group in the study by Hemkens et al [7].…”

IDegAsp (insulin degludec + insulin aspart) for the management of type 2 diabetes: current status

“…The use of basal insulin in the management of T2DM as the initial insulin treatment is currently well accepted, although this partly relates to insulin therapy generally being started once the insulin secretory defect is well advanced [12]. The use of combination basal and mealtime regimens in T2DM depends on the observation that mealtime glucose excursions can be a problem with basal insulin alone, even at the time when it is started and certainly after some years [13], that continuing islet β-cell decline occurs with time [14], and that some groups of people, notably of Asian origin, tend to have greater mealtime glucose excursions [15].…”