Comparison of Different Insulin Regimens in Elderly Patients With NIDDM

Wolffenbuttel, Bruce H. R.; Sels, J. P. J. E.; Rondas-Colbers, G. J. W. M.; Menheere, P. P. C. A.; Kruseman, A. C. Nieuwenhuijzen

doi:10.2337/diacare.19.12.1326

Cited by 58 publications

(33 citation statements)

References 22 publications

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“…However, previous studies using NPH insulin in combination with OADs did not show better glycemic control in terms of HbA 1c reduction in comparison to insulin monotherapy with premixed insulin (15)(16)(17). In the present study, insulin treatment initiated by adding insulin glargine to OADs resulted in a significantly greater improvement in glycemic control compared with 70/30 insulin alone.…”

Section: Conclusion -These Resultsmentioning

confidence: 86%

Comparison of Basal Insulin Added to Oral Agents Versus Twice-Daily Premixed Insulin as Initial Insulin Therapy for Type 2 Diabetes

et al. 2005

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OBJECTIVE -To compare the efficacy and safety of adding once-daily basal insulin versus switching to twice-daily premixed insulin in type 2 diabetic patients insufficiently controlled by oral antidiabetic agents (OADs). RESEARCH DESIGN AND METHODS-In a 24-week, multinational, multicenter, open, parallel group clinical trial, 371 insulin-naïve patients with poor glycemic control (fasting blood glucose [FBG] Ն120 mg/dl, HbA 1c 7.5-10.5%) on OADs (sulfonylurea plus metformin) were randomized to once-daily morning insulin glargine plus glimepiride and metformin (glargine plus OAD) or to 30% regular/70% human NPH insulin (70/30) twice daily without OADs. Insulin dosage was titrated to target FBG Յ100 mg/dl (both insulins) and predinner blood glucose Յ100 mg/dl (70/30 only) using a weekly forced-titration algorithm.RESULTS -Mean HbA 1c decrease from baseline was significantly more pronounced (Ϫ1.64 vs. Ϫ1.31%, P ϭ 0.0003), and more patients reached HbA 1c Յ7.0% without confirmed nocturnal hypoglycemia (45.5 vs. 28.6%, P ϭ 0.0013) with glargine plus OAD than with 70/30. Similarly, FBG decrease was greater with glargine plus OAD (adjusted mean difference Ϫ17 mg/dl [-0.9 mmol/l], P Ͻ 0.0001), and more patients reached target FBG Յ100 mg/dl with glargine plus OAD than with 70/30 (31.6 vs. 15.0%, P ϭ 0.0001). Glargine plus OAD patients had fewer confirmed hypoglycemic episodes than 70/30 patients (mean 4.07 vs. 9.87/patient-year, P Ͻ 0.0001).CONCLUSIONS -Initiating insulin treatment by adding basal insulin glargine once daily to glimepiride plus metformin treatment was safer and more effective than beginning twice-daily injections of 70/30 and discontinuing OADs in type 2 diabetic patients inadequately controlled with OADs. Diabetes Care 28:254 -259, 2005T he association between poor glycemic control and the occurrence of micro-and macrovascular complications has been demonstrated in patients with type 1 and type 2 diabetes (1-3); however, achieving glycemic control, preferably with HbA 1c values Ͻ7%, can markedly reduce the risk of such complications (4) and is now recommended clinical practice (5,6). In many patients, insulin treatment is required to achieve good glycemic control (1).Consensus opinion on how or when to initiate insulin treatment in type 2 diabetic patients is lacking, and treatment regimens are known to vary between countries. Since most patients with type 2 diabetes are older and physicians' time is limited, the insulin regimen should be easy to apply. However, few studies have directly compared the leading methods. We studied two commonly used, simple regimens for initiating insulin therapy. One approach consists of stopping oral antidiabetic agent (OAD) therapy and initiating two injections of insulin, often premixed insulin containing a fixed ratio of regular and intermediateacting insulin (NPH), administered twice daily. The European Diabetes Policy Group (5) recommended that, in the majority of patients with type 2 diabetes, insulin therapy should be initiated using premixed insulin twice daily. N...

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Section: Conclusion -These Resultsmentioning

confidence: 86%

Comparison of Basal Insulin Added to Oral Agents Versus Twice-Daily Premixed Insulin as Initial Insulin Therapy for Type 2 Diabetes

et al. 2005

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“…There is no agreed upon optimal mode of initiating insulin in this situation. In recent years, adding NPH insulin at bedtime (1)(2)(3) or 70/30 premixed insulin at suppertime (4) to the oral medications have been studied. Adding NPH insulin at bedtime has yielded similar improvements in control as two or more injections of insulin for 3 (1), 6 (2), or 12 (3) months.…”

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confidence: 99%

Starting Insulin Therapy in Type 2 Diabetic Patients

Davidson

2005

Diabetes Care

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“…76 Both studies showed a greater Review weight gain (0.77-1.37 kg) with glargine than with detemir, but a similar risk of hypoglycemia. In our analysis of four studies that compared morning with bedtime administration of basal insulin, 18,49,54,55 we found no significant difference in HbA 1c reduction or weight gain. Data were insufficient for a pooled estimate of the effect on hypoglycemia.…”

Section: Choice Of Insulinmentioning

confidence: 89%

Initiating insulin in patients with type 2 diabetes

Lau¹,

Tang²,

Halapy³

et al. 2012

CMAJ

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T ype 2 diabetes has become a worldwide epidemic 1 and is associated with multiple complications that can be prevented by modifying risk factors and optimizing glycemic control. 2 The optimization of glycemic control often requires the use of multiple agents, including insulin.Insulin is an important component of antihyperglycemic therapy, yet there are many perceived barriers.3 Existing guidelines do not specifically address the topic of insulin initiation. 4 We review and analyze the evidence from randomized controlled trials on insulin initiation and address adverse effects and barriers. We also discuss the selection of an insulin regimen, titration and delivery of care, as well as when and how to combine insulin therapy with oral antihyperglycemic agents. A summary of our systematic review and meta-analysis is available in Box 1. When should insulin be started?Clinical practice guidelines vary as to the recommended criteria for the initiation of insulin therapy in pa tients with type 2 diabetes. Factors that are considered include the control of blood glucose levels and comorbidities that affect choice of treatment. Glucose controlThe American Diabetes Association and the European Association for the Study of Diabetes developed a consensus algorithm wherein basal insulin is recommended as a second-line agent if the glycated hemoglobin (HbA 1 c ) value is greater than 7.0% after metformin monotherapy.5 Similarly, the International Diabetes Federation recommends that insulin be started if optimized oral antihyperglycemic therapy and lifestyle interventions are unable to maintain blood glucose at target levels. 6 In contrast, the Canadian Diabetes Association recommends that insulin be considered as a first-line agent if the HbA 1c value is 9.0% or greater in pa tients with newly diagnosed diabetes or if there is symptomatic hyperglycemia with metabolic decompensation (defined as polyuria, polydipsia and weight loss), and as a second-line agent if the HbA 1c is still not at target levels (consensus recommendation). 4Although no randomized controlled trials have looked at the impact on cardiovascular outcomes of insulin initiation early in the course of type 2 diabetes, early intensive control of blood glucose levels was assessed in the United Kingdom Prospective Diabetes Study (UKPDS). The study compared intensive glycemic control (with metformin, secretagogue or insulin therapy) and conventional glycemic control in patients with newly diagnosed diabetes and found that those in the intensive treatment group had reduced microvascular and macrovascular complications in long-term follow-up. 7,8 Early insulin initiation has been shown to improve and preserve β-cell function, 9 and the ongoing Outcome Reduction With Initial Glargine Intervention (ORIGIN) trial will assess the impact of an early basal insulin strategy on cardiovascular outcomes. 10 ComorbiditiesCareful monitoring of glycemic control is necessary when treating diabetes in patients with renal or hepatic failure. Many oral antihyperglycemic agents are c...

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Comparison of Different Insulin Regimens in Elderly Patients With NIDDM

Cited by 58 publications

References 22 publications

Comparison of Basal Insulin Added to Oral Agents Versus Twice-Daily Premixed Insulin as Initial Insulin Therapy for Type 2 Diabetes

Comparison of Basal Insulin Added to Oral Agents Versus Twice-Daily Premixed Insulin as Initial Insulin Therapy for Type 2 Diabetes

Starting Insulin Therapy in Type 2 Diabetic Patients

Initiating insulin in patients with type 2 diabetes

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