A randomized multicentre trial of insulin glargine compared with NPH insulin in people with type 1 diabetes

Home, Philip; Rosskamp, R.; Forjanic-Klapproth, J; Dressler, A

doi:10.1002/dmrr.572

Cited by 65 publications

(34 citation statements)

References 12 publications

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“…Home and colleagues (2005) also found that once-daily insulin glargine produces a level of glycemic control comparable to that provided by once- or twice-daily NPH insulin, without an increased risk of hypoglycemia. However, treatment satisfaction and psychologic wellbeing were also evaluated in these patients (Witthaus et al 2001) and showed that insulin glargine has an advantage with respect to psychologic outcomes, as people are apparently more satisfied with treatment with insulin glargine compared with NPH insulin.…”

Section: Clinical Efficacy Of Insulin Glarginementioning

confidence: 81%

“…Conventional longer-acting insulin preparations, such as NPH, have not provided consistent 24-hour cover, thus necessitating twice-daily administration in some individuals. NPH insulin also has an early peak at around 4 to 6 hours following subcutaneous injection and this can be associated with hypoglycemia, a limiting and potentially dangerous adverse effect (Home et al 2005). Insulin glargine is a recently developed, long-acting basal insulin that has been found to have a stable absorption rate without any pronounced peaks in plasma concentration, thereby providing near 24-hour cover (Heinemann et al 2000; Lepore et al 2000; Owens et al 2000; Scholtz et al 2005) (Fig.…”

Section: Clinical Efficacy Of Insulin Glarginementioning

confidence: 99%

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Insulin glargine in the management of diabetes mellitus: an evidence-based assessment of its clinical efficacy and economic value

Clissold

Clissold²

2007

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Introduction:Diabetes is a chronic disease associated with high morbidity and mortality, which represents a major public health concern. Interventions that can enhance patient care and reduce clinic visits will not only relieve some of this burden, they will also improve patient QOL and wellbeing.Aims:This review assesses the evidence for the use of insulin glargine in type 1 and type 2 diabetes mellitus.Evidence review:Once-daily insulin glargine has a prolonged, peakless activity profile, making it a candidate as a long-acting (basal) insulin. In combination with bolus insulin to cover prandial glucose surges, it facilitates a more physiologic approach to patient management. Evidence from large, randomized, controlled clinical trials in patients with type 1 diabetes has confirmed its effectiveness and tolerability relative to neutral protamine hagedorn (NPH) insulin, with a tendency toward causing less hypoglycemia. In patients with type 2 diabetes requiring insulin therapy, once-daily insulin glargine has proven to be clinically superior to NPH insulin in terms of providing at least as effective glycemic control, but with significantly fewer episodes of nocturnal hypoglycemia. A variety of economic analyses have confirmed the cost effectiveness of insulin glargine in type 1 and type 2 diabetes and in particular it was shown to be significantly superior to NPH insulin.Clinical value:Insulin glargine has established itself as a first-line choice in patients with type 1 diabetes, including children (>6 years) and adolescents, and is a recommended treatment option. In patients with type 2 diabetes it is clearly associated with less hypoglycemia than NPH insulin, and this may help overcome one of the major barriers to starting insulin therapy in this class of patient. Thus, insulin glargine is a valuable addition to the therapeutic armamentarium available to physicians and it has the potential to significantly improve the quality of life of patients with diabetes.

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Section: Clinical Efficacy Of Insulin Glarginementioning

confidence: 81%

Section: Clinical Efficacy Of Insulin Glarginementioning

confidence: 99%

Insulin glargine in the management of diabetes mellitus: an evidence-based assessment of its clinical efficacy and economic value

Clissold

Clissold²

2007

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“…Insulin glargine is a basal insulin with a duration of action of 20-24 h and a flatter effect curve than NPH insulin [5,6]. Several studies have evaluated the mean effect on HbA1c of insulin glargine compared with NPH insulin, but the results have been contradictory [7][8][9][10][11][12][13][14][15][16][17][18][19]. To the best of our knowledge, no studies have addressed any concept to study responders and non-responders for insulin glargine or any other types of insulins.…”

Section: Introductionmentioning

confidence: 91%

A method to predict the metabolic effects of changes in insulin treatment in subgroups of a large population based patient cohort

et al. 2007

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This case-control study was designed to analyse predictors of the effects on HbA1c levels in 4001 type 1 and type 2 diabetic patients after changing their insulin treatment. Patients from 15 outpatient diabetic clinics were treated with basal insulin and multiple injections of short-acting insulin. The effects on HbA1c of changing from NPH insulin to insulin glargine as basal insulin were studied, compared to patients continuing with NPH insulin. The following possible predictors were examined with multiple regression analysis: age, sex, type and duration of diabetes, smoking, metformin use, insulin requirement, number of basal doses per day, BMI and HbA1c at baseline. The difference between the two regression functions yielded the effect of switching treatment to insulin glargine compared to continuing with NPH insulin. Male gender, low BMI and high baseline HbA1c levels were significant predictors for a greater decrease in HbA1c when changing to insulin glargine. For example, for men with a BMI of 25 and an HbA1c of 8.0%, there was a calculated mean benefit in HbA1c of 0.26 percentage points by changing to insulin glargine, whereas women with a BMI 30 had no benefit of such a change. Thus, changing to insulin glargine had best effect in male patients with low BMI. This is one of the first studies designed to find responders to insulin treatment. Analyses of predictors may prove useful in order to tailor insulin treatment in diabetic patients in clinical practice. The clinical effects need to be confirmed in other studies and randomised controlled trials.

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“…Intensive treatment aiming for normoglycemia delays the onset and slows the progression of retinopathy, nephropathy and neuropathy as well as reduces the risk for cardiovascular events [1,5,6]. Recent advances to improve glycemic control include switching to long-acting glargine insulin, which has proven to be safe and effective in patients with both Type 1 [7,8] and Type 2 diabetes [9,10]. Novel classes of oral antihyperglycemic drugs for patients with Type 2 diabetes, the insulin-sensitizing thiazolidinediones, selectively activate the nuclear transcription factor peroxisome-proliferator-activated receptor-γ (PPARγ ) [11].…”

Section: Glycemic Controlmentioning

confidence: 99%

Novel Therapeutics for Diabetic Micro- and Macrovascular Complications

Soro‐Paavonen

Forbes

2006

CMC

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Diabetic patients have a two- to four-fold increased risk for the development of microvascular (renal, neuronal and retinal) and macrovascular complications. Unfortunately, these complications may develop in both Type 1 and Type 2 diabetic patients even with careful glycaemic, blood pressure and lipid control. With the worldwide increase in the incidence diabetes, new strategies to prevent the complications are urgently needed. Mediators of vascular damage of diabetes include poor glycemic control, lipoprotein abnormalities, hypertension, oxidative stress, inflammation and advanced glycation end-products (AGEs), which are modified proteins formed by non-enzymatic glycation. AGEs are resistant to enzymatic degradation and therefore very stable, thus their accumulation continues throughout aging. AGE accumulation causes arterial stiffening in the vessel wall, glomerulosclerosis in the kidney, and vascular hyperpermeability in the retina. Through their interaction with their putative receptor the so-called receptor for AGEs (RAGE), AGEs activate endothelial cells and macrophages, generate reactive oxygen species (ROS), induce overexpression of vascular endothelial growth factor (VEGF) and vascular cell adhesion molecule-1 (VCAM-1), and quench nitric oxide (NO). The pharmacological treatment currently available for either Type 1 or Type 2 diabetic patients does not directly address the excess accumulation of AGEs. Novel compounds that inhibit AGE formation, cleave AGE cross-links or reverse their interaction with RAGE are now accessible and could prove useful in meeting this challenge. Other strategies such as inhibition of the hexosamine pathway, vitamin therapy to reduce oxidation and AGE accumulation, reduction of the ROS, or blocking the actions of growth factors or intracellular messengers of cell differentiation are also currently under research. This review will recount recent advances in the development of therapeutic approaches for inhibiting and treating the development of diabetic end-organ damage.

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A randomized multicentre trial of insulin glargine compared with NPH insulin in people with type 1 diabetes

Abstract: A single, bedtime, subcutaneous dose of insulin glargine provided a level of glycaemic control at least as effective as NPH insulin, without an increased risk of hypoglycaemia.

Cited by 65 publications

References 12 publications

Insulin glargine in the management of diabetes mellitus: an evidence-based assessment of its clinical efficacy and economic value

Insulin glargine in the management of diabetes mellitus: an evidence-based assessment of its clinical efficacy and economic value

A method to predict the metabolic effects of changes in insulin treatment in subgroups of a large population based patient cohort

Novel Therapeutics for Diabetic Micro- and Macrovascular Complications

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