Adding a single daily dose of glarine to oral antidiabetic agents is an effective treatment in controlling blood sugars. In patients aged 65 and more with poorly controlled type 2 diabetes, adding a single daily injection of insulin glargine to oral antidiabetic agents is a convenient and effective approach to treatment, German researchers report in the February issue of the Journal of the American Geriatrics Society.
As lead investigator Dr. Hans U. Janka from Klinikum Bremen-Nord II, told Diabetes In Control, "Elderly diabetic patients — the majority of insulin-requiring people — need a simple but very effective method for initiating insulin therapy, when oral antidiabetic medicine fails."
Worldwide, he added, the most common form of insulin treatment involves twice-daily injections of premixed 30% regular and 70% NPH insulin (70/30).
In an earlier trial involving 371 insulin-nave poorly controlled type 2 diabetics, Dr. Janka and colleagues found that adding once-daily basal glargine insulin to prior oral antidiabetic therapy provided better glycemic control with a lower incidence of hypoglycemia than replacing oral therapy with twice-daily 70/30 insulin.
In the current study, the researchers conducted a subgroup analysis of 130 of these patients aged 65 and older with fasting blood glucose levels at or above 6.7 mmol/L and HbA1c between 7.5% and 10.5% despite oral antidiabetic therapy. Sixty-seven added glargine to oral antidiabetic therapy and 63 replaced oral therapy with twice-daily 70/30 insulin.
The simple combination of glargine and oral therapy, Dr. Janka pointed out "was in every aspect superior to 2 injections of premixed insulin: Better fasting blood glucose, better HbA1c, markedly less hypoglycemia, less weight gain, markedly less insulin dose, better results in quality of life parameters, and, finally, less costs — due to less necessary blood glucose tests."
The findings mirror those reported in the overall patient population of this study, and Dr. Janka concluded that the combination approach "is an unbeatably simple and effective method for initiating insulin therapy, particularly in the elderly."
J Am Geriatr Soc 2007;55:182-188.
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Low testosterone in men may be diabetes risk factor: Men with testosterone levels in the low-normal range are much more likely to have diabetes than those with higher levels, whether or not they are obese, researchers report. "Low testosterone levels are common among men with diabetes and there is growing evidence that low testosterone may be a risk factor for developing diabetes," Dr. Elizabeth Selvin from Johns Hopkins Bloomberg School of Public Health in Baltimore commented. She and her colleagues analyzed data from 1,413 men 20 years or older. Diabetes had been diagnosed in 101 men. After the influence of age, race and obesity was factored in, men with the lowest levels of testosterone were four times more likely to have diabetes than men with the highest levels. Similar results were found when only the bioavailable testosterone was measured. These data, the researchers write, support the hypothesis that male hormones directly influence sugar metabolism and the development of insulin resistance, which is seen just before diabetes occurs, independent of the effects of obesity. Diabetes Care, February 2007.