QOL Benefit Seen With Insulin Glargine Added to Type 2 Diabetes Regimen

For type-2 diabetic patients with inadequate blood glucose control despite treatment with two oral diabetes drugs, the addition of either insulin glargine or rosiglitazone results in comparable levels of improvement in glucose control, investigators report. However, insulin glargine is associated with greater improvement in quality of life (QOL) than is rosiglitazone.

Co-authors Dr. Aaron I. Vinik, based at Eastern Virginia Medical School in Norfolk, and Dr. Quanwu Zhang, from Sanofi-Aventis US in Bridgewater, New Jersey, note that, over time, most patients with type 2 diabetes will require more than one drug to maintain optimal blood glucose levels.

One option is to add a long-acting, once-daily insulin analog to the patients’ oral regimen. However, the authors note in their paper, little is known about the effect on quality of life.

The researchers studied 214 diabetic adults who were randomly assigned to insulin glargine (n = 104) or rosiglitazone (n = 110). At baseline, each patient was taking metformin and a sulfonylurea. The average fasting plasma glucose (FPG) score was 187 mg/dL in the insulin group and 191 in the rosiglitazone group; corresponding values for glycosylated hemoglobin were 8.8% and 8.7%.

Insulin glargine was administered at bedtime at a starting dose of 10 IU/day, titrated weekly to achieve a target FPG < 100 mg/dL. Rosiglitazone was started at 4 mg daily, and raised to 8 mg at 6 weeks if FPG was still over 100 mg/dL.
After 24 weeks, FPG averaged 120 among those on insulin and 148 among those taking rosiglitazone. Glycosylated hemoglobin values were 7.1% and 7.2%, respectively.

Dr. Vinik and Dr. Zhang observed that health-related QOL scores improved in both groups, but significantly more so among those taking insulin glargine.

Individual domain scores for mood, ophthalmologic symptoms, and fatigue were also significantly more improved by insulin glargine. Other measures, including hyperglycemia, neuropathic pain, and cognitive function showed a nonsignificant trend toward greater improvement when patients used insulin glargine, the authors note.

Moreover, patients taking rosiglitazone reported more adverse events (28.6%) than those using insulin glargine (6.7%, p < 0.0001). Less weight gain occurred in the insulin group.

Given the negative perceptions of insulin treatment and concerns about self-administration of insulin, "the improvements from baseline in health-related QOL associated with insulin glargine therapy in this study are particularly reassuring," Drs. Vinik and Zhang conclude.

Diabetes Care 2007;30:795-800.

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DID YOU KNOW:

Type 1 Diabetes Control is Not Helped by Cinnamon:  Earlier studies found that cinnamon might help control blood sugar levels in people with type 1 diabetes. However, recent findings shows that it is unlikely.  The previous story stated that fat cells were helped recognize and respond to insulin by cinnamon. Also, people with type 2 that had a small amount of cinnamon for 40 days had drops in blood sugar levels. Recent researchers reported, "In essentially all outcomes…the trend favored the placebo group, although did not achieve statistical significance." The researcher, Dr. Kevin M. Curtis, had given 1 gram of cinnamon per day to 72 adolescents.  Diabetes Care, April 07