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Difference in Treatment Satisfaction Between Long- versus Intermediate-Acting Basal Insulin in Combination with Oral Antidiabetic Agents

New research has suggested medication combination can optimize patients’ quality of life…

Neural protamine Hagedorn (NPH) is an intermediate insulin that reduces blood glucose levels. Its peak in activity is at 4-6 hours after administration and duration of action is between 12-16 hours. Glargine duration of action is prolonged to 24 hours with one injection. There are two studies that concluded that patients experienced a slightly higher treatment satisfaction with glargine (p < 0.02 and p = 0.0634). Despite the results from previous studies, further study was required in order to explain the difference between the two treatment groups.

The aim of the study was to evaluate the outcome of glargine versus NPH insulin on a composite Diabetes Related Quality of Life score (DRQoL), consisting of a standardized and unweighted Insulin Treatment Experience Questionnaire Score (ITEQ), a Problem Areas in Diabetes (PAID) questionnaire score, and the mental health score in the Short Form (SF)-12® Health Survey. The study was designed as a randomized controlled study.

The results showed that patients (mean age 62.3 ± 9.0; 39.5 % female) had an average diabetes duration of 9.6 ± 5.9 years, an average baseline HbA1c of 8.15 ± 0.72 %, and an average fasting blood sugar level of 9.37 ± 2.19 mmol/L. Combining all data from both periods for each insulin treatment, on a 0–100 scale, the average DRQoL score was 69.6 (±9.04) with glargine and 70.0 (±9.40) with NPH. Neither an outcome of treatment with insulin glargine vs NPH insulin (p = 0.31) nor a period outcome (p = 0.96), nor a sequence outcome (p = 0.76) was observed using ANCOVA.

To conclude, in patients with sub-optimal blood glucose concentration at baseline, and a low target accomplishment rate in combination with a low rate of low blood glucose, differences in the patient reported effects evaluated in this study were insignificant between insulin glargine and NPH insulin.

Practical Pearls:

  • Both NPH and glargine had similar results on the primary evaluation criterion, DRQoL
  • The PRO questionnaires that was used in the study were not significant in comparing the two groups.
  • Further research should be conducted to determine a true differences between NPH and glargine on the impact of treatment satisfaction.

Hermanns N, Kulzer B, Kohlmann T, et al. “Treatment satisfaction and quality-of-life between type 2 diabetes patients initiating long- vs. intermediate-acting basal insulin therapy in combination with oral hypoglycemic agents–a randomized, prospective, crossover, open clinical trial.” Health Qual Life Outcomes. 2015;13:77.