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A valid alternative in type 2 patients who are poorly controlled on prior CIT is switching them from conventional insulin therapy (CIT) to a combination of insulin glargine (Lantus) and oral anti-diabetic drugs, suggested from new data.
Dr. Ralf Schiel, University of Jena, in Jena, Germany, presented results at the 18th International Diabetes Federation (IDF) Congress in 52 patients who had been randomized to 16 weeks’ of glargine once daily in the morning with glimepiride, glargine with glimepiride and metformin, or continued CIT.
Prior to study entry, subjects had type 2 diabetes for a range of 6 months to 5 years, a hemoglobin A1c (HbA1c) level greater than 7.8%, and were receiving premixed CIT. Baseline characteristics were generally similar in the three treatment groups, except that patients continuing CIT were significantly older.
Results showed that HbA1c decreased in the three treatment groups, and there were no differences among the three groups at the end of the trial with respect to fasting blood glucose levels and frequency of hypoglycemia.
Three patients in the glargine groups had to stop treatment with glargine and oral agents prematurely because of gastrointestinal discomfort and diarrhea.
Treatment satisfaction assessed at the end of the study by a patient-completed questionnaire showed similar levels of treatment satisfaction in the three groups.
Overall, 88% of 17 patients treated with glargine plus glimepiride and 67% of 18 patients who received glargine with glimepiride and metformin chose to continue therapy with glargine and oral agents. Six percent switched to multiple daily insulin injections.
"The results indicate that treatment regimens comprising insulin glargine plus oral anti-diabetic drugs afford at least equivalent glycemic control compared with optimized conventional insulin therapy in type 2 diabetics poorly controlled on their prior CIT," Dr. Schiel said. Accordingly, he added that a switch to glargine is a feasible option in patients on long-term CIT.
The study was supported by Aventis Pharma in Frankfurt.
IDF: [Study title: Quality of glycemic control and well-being of patients with Type 2 diabetes mellitus after switching from conventional insulin therapy to once-daily insulin glargine in combination with oral antidiabetic drugs – SWITCH-pilot, a prospective, randomized trial. Abstract 788]
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