Less nocturnal hypoglycemia and better post-dinner glucose control with bedtime insulin glargine compared with bedtime NPH insulin during insulin combination therapy in type 2 diabetes. HOE 901/3002 Study Group.

Abstract

OBJECTIVE -Available basal insulin formulations do not provide a constant and reliable 24-h insulin supply. We compared the efficacy and safety of glargine (a long-acting insulin analog) and NPH insulins in insulin-naive type 2 diabetic patients treated with oral antidiabetic agents.RESEARCH DESIGN AND METHODS -There were 426 type 2 diabetic patients (age 59 ± 9 years, BMI 28.9 ± 4.3 kg/m 2 , mean ± SD) with poor glycemic control on oral antidiabetic agents randomized to treatment for 1 year with bedtime insulin glargine or bedtime NPH insulin. Oral agents were continued unchanged. The fasting blood glucose (FBG) target was 6.7 mmol/l (120 mg/dl). RESULTS -Average glycemic control improved similarly with both insulins (HbA 1c[reference range Ͻ6.5%] 8.3 ± 0.1 vs. 8.2 ± 0.1% at 1 year, glargine vs. NPH, mean ± SEM, P Ͻ 0.001 vs. baseline for both). However, there was less nocturnal hypoglycemia (9.9 vs. 24.0% of all patients, glargine vs. NPH, P Ͻ 0.001) and lower post-dinner glucose concentrations (9.9 ± 0.2 vs. 10.7 ± 0.3 mmol/l, P Ͻ 0.02) with insulin glargine than with NPH. Insulin doses and weight gain were comparable. In patients reaching target FBG, HbA 1c averaged 7.7 and 7.6% in the glargine and NPH groups at 1 year.CONCLUSIONS -Use of insulin glargine compared with NPH is associated with less nocturnal hypoglycemia and lower post-dinner glucose levels. These data are consistent with peakless and longer duration of action of insulin glargine compared with NPH. Achievement of acceptable average glucose control requires titration of the insulin dose to an FBG target Յ6.7 mmol/l. These data support use of insulin glargine instead of NPH in insulin combination regimens in type 2 diabetes.

Insulin and its analogue glargine do not affect viability and proliferation of human coronary artery endothelial and smooth muscle cells

“…However, due to peripheral insulin resistance, most of the patients needed rather high insulin dosages [4,5]. In this and other trials, the insulin analogue glargine was shown to improve glycaemic control with significantly less nocturnal hypoglycaemia than NPH insulin [2][3][4]6]. Therefore, insulin and its analogue glargine are increasingly being used in type 2 diabetic patients to reach the desired HbA 1 c levels.…”

“…Due to the natural course of type 2 diabetes with its progressive loss of beta cell function, it often becomes necessary to add insulin to oral therapy to achieve better glycaemic control [1][2][3]. Recently, Riddle et al [4] demonstrated that even a simple insulin regimen lowers HbA 1 c levels to 6.9% in type 2 diabetic patients.…”

Efficacy and safety of switching from basal insulin to once‐daily insulin degludec/insulin aspart in Japanese patients with inadequately controlled type 2 diabetes: A 4‐week, randomized, open‐label, treat‐to‐target study

“…It involves the addition of once‐daily long‐acting insulin, such as insulin glargine or insulin degludec, to ongoing OHA therapy. Several clinical trials have supported the efficacy of BOT3, 4, 5. While supplementing basal insulin is expected to reduce the fasting plasma glucose level, some patients still fail to achieve the target hemoglobin A1c (HbA1c), probably because of postprandial hyperglycemia.…”

Current Therapeutic Options in Type 2 Diabetes Mellitus: A Practical Approach

“…Also, there is no evidence that bedtime glargine insulin results in better glycemic control than bedtime neutral protamine Hagedorn (NPH) insulin, although there is certainly less hypoglycemia with the former. 61 Use of glargine insulin increases costs by 65% versus NPH insulin. As is noted in table 3, triple oral agent therapy costs over twice as much as SU and metformin plus bedtime NPH insulin for a similar reduction in HbA 1c .…”