|
 |
|
|||||||
|
|||||||||
© 2005 by the American Diabetes Association, Inc.
Clinical Care/Education/Nutrition |
Comparison of Basal Insulin Added to Oral Agents Versus Twice-Daily Premixed Insulin as Initial Insulin Therapy for Type 2 Diabetes
1 Zentralkrankenhaus, Bremen-Nord, Bremen, Germany
2 Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health and Science University, Portland, Oregon
3 Aventis Pharma Deutschland, Bad Soden, Germany
4 Department of Medicine, University of Helsinki, Helsinki, Finland
Address correspondence and reprint requests to Prof. Hans U. Janka, Zentralkrankenhaus, Bremen-Nord, II Medizinische Abteilung, Hammersbecker Str. 228, 28755 Bremen, Germany. E-mail: hans.janka{at}klinikum-bremen-nord.de
OBJECTIVE—To compare the efficacy and safety of adding once-daily basal insulin versus switching to twice-daily premixed insulin in type 2 diabetic patients insufficiently controlled by oral antidiabetic agents (OADs).
RESEARCH DESIGN AND METHODS—In a 24-week, multinational, multicenter, open, parallel group clinical trial, 371 insulin-naïve patients with poor glycemic control (fasting blood glucose [FBG] 
120 mg/dl, HbA1c 7.5–10.5%) on OADs (sulfonylurea plus metformin) were randomized to once-daily morning insulin glargine plus glimepiride and metformin (glargine plus OAD) or to 30% regular/70% human NPH insulin (70/30) twice daily without OADs. Insulin dosage was titrated to target FBG 
100 mg/dl (both insulins) and predinner blood glucose 100 mg/dl (70/30 only) using a weekly forced-titration algorithm.
RESULTS—Mean HbA1c decrease from baseline was significantly more pronounced (–1.64 vs. –1.31%, P = 0.0003), and more patients reached HbA1c 7.0% without confirmed nocturnal hypoglycemia (45.5 vs. 28.6%, P = 0.0013) with glargine plus OAD than with 70/30. Similarly, FBG decrease was greater with glargine plus OAD (adjusted mean difference –17 mg/dl [–0.9 mmol/l], P < 0.0001), and more patients reached target FBG 100 mg/dl with glargine plus OAD than with 70/30 (31.6 vs. 15.0%, P = 0.0001). Glargine plus OAD patients had fewer confirmed hypoglycemic episodes than 70/30 patients (mean 4.07 vs. 9.87/patient-year, P < 0.0001).
CONCLUSIONS—Initiating insulin treatment by adding basal insulin glargine once daily to glimepiride plus metformin treatment was safer and more effective than beginning twice-daily injections of 70/30 and discontinuing OADs in type 2 diabetic patients inadequately controlled with OADs.
Abbreviations: FBG, fasting blood glucose • OAD, oral antidiabetic agent
CiteULike 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Find additional patient-related information at:
This article has been cited by other articles:
|
|
 |
|
  L. F Van Gaal, S. W Gutkin, and M. A Nauck Exploiting the antidiabetic properties of incretins to treat type 2 diabetes mellitus: glucagon-like peptide 1 receptor agonists or insulin for patients with inadequate glycemic control? Eur. J. Endocrinol., June 1, 2008; 158(6): 773 - 784. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. C. Riddle Starting and Advancing Insulin for Type 2 Diabetes: Algorithms and Individualized Methods Are Both Necessary J. Clin. Endocrinol. Metab., February 1, 2008; 93(2): 372 - 374. [Full Text] [PDF]
|
|
|
|
 |
|
 S. N. Davis, D. Johns, D. Maggs, H. Xu, J. H. Northrup, and R. G. Brodows Exploring the Substitution of Exenatide for Insulin in Patients With Type 2 Diabetes Treated With Insulin in Combination With Oral Antidiabetes Agents Diabetes Care, November 1, 2007; 30(11): 2767 - 2772. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. R. Holman, K. I. Thorne, A. J. Farmer, M. J. Davies, J. F. Keenan, S. Paul, J. C. Levy, and the 4-T Study Group Addition of Biphasic, Prandial, or Basal Insulin to Oral Therapy in Type 2 Diabetes N. Engl. J. Med., October 25, 2007; 357(17): 1716 - 1730. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Blonde Easing the Transition to Insulin Therapy in People With Type 2 Diabetes The Diabetes Educator, July 1, 2007; 33(Supplement_7): 232S - 240S. [Full Text] [PDF]
|
|
|
|
|
|
L. Haas and W. Polonsky The Tipping Point: Overcoming Barriers The Diabetes Educator, July 1, 2007; 33(Supplement_7): 248S - 250S. [Full Text] [PDF]
|
|
|
|
|
|
H. Yki-Jarvinen, L. Juurinen, M. Alvarsson, T. Bystedt, I. Caldwell, M. Davies, S. Lahdenpera, G. Nijpels, and M. Vahatalo Initiate Insulin by Aggressive Titration and Education (INITIATE): A randomized study to compare initiation of insulin combination therapy in type 2 diabetic patients individually and in groups Diabetes Care, June 1, 2007; 30(6): 1364 - 1369. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Monnier, C. Colette, G. J. Dunseath, and D. R. Owens The Loss of Postprandial Glycemic Control Precedes Stepwise Deterioration of Fasting With Worsening Diabetes Diabetes Care, February 1, 2007; 30(2): 263 - 269. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. T. Bloomgarden Achieving Glycemic Goals in Type 2 Diabetes Diabetes Care, January 1, 2007; 30(1): 174 - 180. [Full Text] [PDF]
|
|
|
|
|
|
D. M. Nathan and On Behalf of the ADA/DASD Consensus Group Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A Consensus Statement From the American Diabetes Association and the European Association for the Study of Diabetes: Response to Cryer, Porta and Trento, and Parkin and Davidson Diabetes Care, January 1, 2007; 30(1): 194 - 196. [Full Text] [PDF]
|
|
|
|
 |
|
 M. F. Bullano, M. D. Fisher, W. D. Grochulski, L. Menditto, and V. J. Willey Hypoglycemic events and glycosylated hemoglobin values in patients with type 2 diabetes mellitus newly initiated on insulin glargine or premixed insulin combination products Am. J. Health Syst. Pharm., December 15, 2006; 63(24): 2473 - 2482. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. D. Mooradian, M. Bernbaum, and S. G. Albert Narrative Review: A Rational Approach to Starting Insulin Therapy Ann Intern Med, July 18, 2006; 145(2): 125 - 134. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N Brown Is it time to re-assess the role of gliclazide? Targeting insulin resistance in type 2 diabetes patients suboptimally controlled with insulin. Postgrad. Med. J., July 1, 2006; 82(969): 471 - 475. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. N. Davis and S. M. Renda Treating to Target in Type 2 Diabetes: A Case Presentation. The Diabetes Educator, June 1, 2006; 32(Supplement_4): 137S - 145S. [Full Text] [PDF]
|
|
|
|
|
|
S. N. Davis and S. M. Renda Psychological Insulin Resistance: Overcoming Barriers to Starting Insulin Therapy. The Diabetes Educator, June 1, 2006; 32(Supplement_4): 146S - 152S. [Full Text] [PDF]
|
|
|
|
|
|
N. N. Zammitt and B. M. Frier Hypoglycemia in Type 2 Diabetes: Pathophysiology, frequency, and effects of different treatment modalities Diabetes Care, December 1, 2005; 28(12): 2948 - 2961. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Malone Medications Associated with Weight Gain Ann. Pharmacother., December 1, 2005; 39(12): 2046 - 2054. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Raskin Initiation of Insulin Therapy in Patients With Type 2 Diabetes Failing Oral Therapy: Response to Mikhail and Cope and to Janka Diabetes Care, November 1, 2005; 28(11): 2811 - 2811. [Full Text] [PDF]
|
|
|
|
|
|
R. J. Heine, L. F. Van Gaal, D. Johns, M. J. Mihm, M. H. Widel, R. G. Brodows, and for the GWAA Study Group* Exenatide versus Insulin Glargine in Patients with Suboptimally Controlled Type 2 Diabetes: A Randomized Trial Ann Intern Med, October 18, 2005; 143(8): 559 - 569. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. E. Mikhail and D. Cope Initiation of Insulin in Patients With Type 2 Diabetes Failing Oral Therapy: Response to Raskin et al. and Janka et al. Diabetes Care, June 1, 2005; 28(6): 1537 - 1538. [Full Text] [PDF]
|
|
|
|
|
|
H. U. Janka Initiation of Insulin in Patients With Type 2 Diabetes Failing Oral Therapy: Response to Raskin et al. and Mikhail and Cope Diabetes Care, June 1, 2005; 28(6): 1538 - 1538. [Full Text] [PDF]
|
|
|
|
|
|
E. M Vivian Comment: insulin strategies for type 2 diabetes mellitus: Author's Reply Ann. Pharmacother., May 1, 2005; 39(5): 976 - 976. [Full Text] [PDF]
|
|
|
|
 |
|
 Comparisons of Insulin Regimens for Type 2 Diabetes Journal Watch (General), March 11, 2005; 2005(311): 1 - 1. [Full Text]
|
|
|
|
|
|
M. B. Davidson Starting Insulin Therapy in Type 2 Diabetic Patients: Does it really matter how? Diabetes Care, February 1, 2005; 28(2): 494 - 495. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |