Clinical Experience with Insulin Glargine in Type 1 Diabetes

Abstract

The Diabetes Control and Complications Trial (DCCT) demonstrated the importance of optimal glycemic control achieved through intensive insulin therapy in reducing the microvascular complications associated with type 1 diabetes. However, the DCCT, which was conducted prior to the availability of insulin analogs, also reported a significant increase in severe hypoglycemia with intensive versus conventional therapy. Insulin analogs were developed to aid patients in achieving better diabetes control by providing insulins with optimized pharmacokinetic and pharmacodynamic characteristics. Insulin glargine was the first long-acting insulin analog with a 24-h duration of action, offering once-daily injection, and has now been in clinical use for over 10 years. The authors performed a systematic search of EMBASE, MEDLINE, and Web of Science (Science Citation Index) to determine the efficacy of insulin glargine in type 1 diabetes in basal-bolus insulin regimens. Randomized controlled trials have demonstrated that glycemic control with insulin glargine is at least comparable to that with neutral protamine Hagedorn (NPH) insulin in adults and in children and adolescents, and with continuous subcutaneous insulin infusion in adults. However, these same trials show a significantly lower risk for hypoglycemia with insulin glargine compared with NPH insulin in adults.

Evaluation of Safety and Efficacy of Glaritus<sup>®</sup> versus Lantus<sup>®</sup> in Combination with Insulin Lispro among Adults with Type 1 Diabetes Mellitus-Phase IV Study

“…In a previous study, hyperglycemia was observed in 60% patients receiving NPH insulin and in very few patients receiving CSII and insulin glargine. In addition, patients receiving insulin glargine experienced fewer nocturnal hypoglycemic episodes [20].…”

“…In addition, insulin glargine reduced glycosylated hemoglobin (HbA1c) levels to a greater extent as compared with NPH insulin [19]. Addition of bolus insulin to therapy with insulin glargine may further boost glycemic control [20]. A study comparing combination of insulin glargine and insulin lispro with insulin lispro mix (25% insulin lispro, 75% insulin lispro protamine suspension) combination demonstrated comparable results between the two treatment groups with respect to glycemic control in patients with type 2 diabetes mellitus (T2DM) [21].…”

Assessing the economic value of maintained improvements in Type 1 diabetes management, in terms of HbA1c, weight and hypoglycaemic event incidence

“…Guideline recommendations are partly founded on cost–utility analyses; however, insulin therapy is highly individualized, and drawing direct comparisons between Type 1 diabetes technologies poses several methodological challenges. For example, insulin titration algorithms and levels of care are heterogeneous across studies and not reflective of routine clinical practice 27; and the reporting of hypoglycaemic events in clinical trials is often confounded by ill‐defined HbA 1c thresholds and nocturnal periods 28. Our study illustrates the value of reducing HbA 1c , hypoglycaemia and body weight irrespective of treatment strategy; therefore, data describing these factors are useful to inform cost‐effectiveness analyses for any therapeutic modality in Type 1 diabetes.…”

Modern insulin therapy with insulin analogues detemir and aspart in children and adolescents: The problems and solutions

“…Применение аналогов инсулина обеспечивает улучшение показателей углеводного обмена при одновременном снижении риска гипогликемий, что чрезвычайно важно для этого контингента пациентов. Терапия аналогами инсулина позволяет использовать более гибкий ре-жим дозирования и улучшить качество жизни как маленьких пациентов, так и их родителей (умень-шить ограничения в питании, успешнее заниматься спортом, получить профессию и улучшить социаль-ную адаптацию) [14][15][16][17]. Однако отсутствие данных по безопасности аналогов инсулина длительного действия у детей младшего возраста (моложе 7 лет) ограничивало возможность применения данных ин-сулинов у маленьких пациентов.…”