More patients in the glargine plus OAD group achieved HbA1c levels of 7% or lower than did patients in the NPH group (49.4% versus 39.0%, respectively). When patients with type 2 diabetes that is poorly controlled with oral hypoglycemic drugs begin insulin therapy, it is better to add once-daily insulin glargine to the oral regimen than to switch entirely to twice-daily NPH insulin injections. Consensus opinion about how and when to begin insulin therapy in type 2 diabetic patients is lacking, the authors explain, and treatment regimens vary from place to place.
Dr. Hans U. Janka from Zentralkrankenhaus in Bremen-Nord, Germany, and colleagues compared two commonly used regimens for initiating insulin therapy: adding once-daily basal glargine insulin to prior oral antidiabetic (OAD) therapy, or replacing OAD therapy with twice-daily NPH insulin.
The improvement in glycosylated hemoglobin over the 24-week study was greater with glargine plus OAD than with NPH insulin, the authors report, and more patients in the glargine plus OAD group achieved HbA1c levels of 7% or lower than did patients in the NPH group (49.4% versus 39.0%, respectively).
Similarly, fasting blood glucose and mean daily glucose levels showed significantly greater improvement with glargine plus OAD compared with NPH insulin, the report indicates.
Moreover, the researchers note, fewer glargine-plus-OAD patients than NPH insulin patients experienced hypoglycemic events. Similar numbers of adverse events were experienced by the two groups of patients.
"These results show that in patients with type 2 diabetes poorly controlled on oral therapy, adding a single injection of insulin glargine to glimepiride and metformin can provide more effective glycemic control than stopping OADs and starting twice-daily 70/30 insulin," the authors conclude.
"The glargine plus OAD regimen in this study required only a single daily injection and a single before-breakfast glucose test to guide therapy and, therefore, should be easy to use in clinical practice," the investigators point out.
Diabetes Care 2005;28:254-259.
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