Comparison of Insulin Glargine Versus NPH Insulin in People with Type 2 Diabetes Mellitus Under Outpatient-Clinic Conditions for 18 Months Using a Basal-Bolus Regimen with a Rapid-Acting Insulin Analogue as Mealtime Insulin

Siegmund, Thorsten; Weber, S.; Blankenfeld, Hannes; Oeffner, A; Schumm-Draeger, P.-M.

doi:10.1055/s-2007-973082

Cited by 24 publications

(20 citation statements)

References 12 publications

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“…In the present review, a total of seven routine practice publications of insulin glargine were identified that reported all key parameters ( Table 1), including two publications representing different follow-up periods of the same study [24][25][26][27][28][29][30]. Seventeen additional studies of routine practice treatment with insulin glargine are listed in Table 1.…”

Section: Insulin Glargine In Routine Clinical Practicementioning

confidence: 99%

“…Siegmund et al reported on outcomes for 63 patients who switched to a basal-bolus insulin regimen with insulin glargine after attending a structured in-patient training program at a single centre in Germany (Table 1) [29]. At baseline, HbA1c was 7.44 ± 1.0%, BMI 29.3 ± 4.34 kg/m 2 , duration of diabetes 10.8 ± 5.25 years and, in addition to NPH plus insulin lispro (63%) or NPH plus insulin as part (37%), approximately 83% of patients received metformin.…”

Section: Insulin Glargine In Basal-bolus Regimensmentioning

confidence: 99%

“…insulin detemir [24,29,36,40,[44][45][46][47][48][49][50]. In many routine clinical practice studies, therefore, a considerable proportion of patients remain above recommended glycemic targets despite transition to insulin.…”

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confidence: 99%

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Long-Acting Insulin Analogs: A Review of “Real-World” Effectiveness in Patients with Type 2 Diabetes

Pollock¹,

Erny-Albrecht²,

Kalsekar³

et al. 2011

CDR

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A systematic review was conducted to evaluate the effectiveness of initiating insulin treatment with insulin glargine or insulin detemir for type 2 diabetes in a routine clinical practice setting. Medline, EMBASE and Cochrane literature databases were searched to identify published "real world" reports. Studies were included in the review if they reported the following; insulin dose, change in HbA1c, change in body weight and hypoglycemic events. In routine practice, decreases inHbA1c associated with insulin glargine and insulin detemir were variable and ranged between approximately -0.3% to -1.5% depending on prior treatment, but switching to insulin analogs was associated with less weight gain than previously reported. Compared with data reported in published trials, hypoglycemic event rates associated with basal analog insulin use in clinical practice were lower in patients initiating insulin and comparable in patients using basal-bolus regimens. Most patients were treated with low doses of insulin analog administered as once daily injections. In routine clinical practice most patients stopped concomitant use of sulfonylureas when initiating insulin analogs and it is likely that this together with the lower dose of insulin influenced outcomes. Nevertheless, despite initiating insulin therapy, it was also apparent that for many patients in routine clinical practice attainment of glycemic goals remains elusive.

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Section: Insulin Glargine In Routine Clinical Practicementioning

confidence: 99%

Section: Insulin Glargine In Basal-bolus Regimensmentioning

confidence: 99%

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Long-Acting Insulin Analogs: A Review of “Real-World” Effectiveness in Patients with Type 2 Diabetes

Pollock¹,

Erny-Albrecht²,

Kalsekar³

et al. 2011

CDR

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“…102 Other studies have documented weight increases or weight stasis after treatment with glargine, although the weight increases, when observed, tended to be less than those occurring with NPH insulin. [103][104][105][106][107][108][109][110][111][112][113][114] The mechanisms behind the weight-sparing trait of insulin detemir have yet to be fully clarified. Insulin detemir is associated with a lower risk of hypoglycemia relative to other basal insulin preparations, 99,108,115 consistent with its greater pharmacokinetic predictability and smooth time-action profile.…”

Section: Weight Gainmentioning

confidence: 99%

Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence

Hartman

2008

Clinical Medicine & Research

116

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Despi te 85 years of research since Banting and Best's isolation of insulin-containing extracts, 1 diabetes still remains one of the most significant causes of morbidity and mortality in the world, and its global impact is likely to accelerate over the coming decades. 2,3 Much of the medical and economic consequences of diabetes are attributable to its associated microvascular and macrovascular complications. [4][5][6] Two classic large-scale clinical studies, the Diabetes Control and Complications Trial (DCCT) 6 and the UK Prospective Diabetes Study (UKPDS), 7 demonstrated that intensive blood-glucose control policies can decrease the frequency of complications, arguing that physicians and patients should strive to mimic, as closely as possible, the serum levels of insulin produced by a healthy person. Secretion of insulin by the pancreas, however, is under complex regulation that depends on the intake of nutrients, other gastrointestinal peptides (e.g., incretins), and overall metabolic levels (i.e., exercise versus rest). 8 These physiological variables, which pose real challenges to the accurate metabolic replacement of insulin, are further complicated by the fact that diabetes requires self-management and therefore depends on the psychology, motivation, and understanding of the patient. A growing body of medical research has demonstrated that intensive control of serum glucose levels can minimize the development of diabetes-related complications. Success with insulin management ultimately depends on how closely a given regimen can mimic normal physiologic insulin release patterns.The new insulin analogs, including the rapid-acting analogs (aspart, lispro, glulisine), the long-acting basal analogs (glargine, detemir), and the premixed insulin analog formulations (75% neutral protamine lispro, 25% lispro; 50% neutral protamine lispro, 50% lispro; 70% protamine aspart, 30% aspart) have been formulated to allow for a closer replication of a normal insulin profile.The rapid-acting analogs can be administered at mealtimes and produce a rapid and short-lived insulin spike to address postprandial glucose elevations, while the long-acting analogs come close to the ideal of a smooth, relatively flat, 24-hour basal insulin supply, with less variability in action compared to NPH insulin. Despite these clear pharmacologic advantages, measurable clinical benefits in a complex disease such as diabetes can be hard to measure.To date, reviews of insulin analog studies have not found a dramatic overall improvement in glycosylated hemoglobin (HbA1c) outcomes compared to traditional human insulins, although all-analog basal-bolus regimens were associated with significantly lower HbA1c than all-human-insulin basal bolus regimens in some studies. Beyond HbA1c comparisons, however, insulin analogs have been shown in many instances to be associated with lower risks of hypoglycemia, lower levels of postprandial glucose excursions, better patient adherence, greater quality of life, and higher satisfaction with treatment.The long-act...

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“…To more closely reproduce endogenous insulin dynamics, several insulin molecules with structural modifications and either a shortened or prolonged action profile (insulin analogues) have been developed for clinical use (2). Replacement of basal insulin in patients with diabetes is usually performed with either NPH insulin or a longacting insulin analogue like insulin glargine (3). Two modifications of the human insulin structure at the C-terminus of the ␤-chain and at position 21 in the ␣-chain lead to the prolonged action profile of insulin glargine because precipitation of the modified insulin molecule in the subcutaneous compartment delays absorption.…”

mentioning

confidence: 99%

Proliferation of Colo-357 Pancreatic Carcinoma Cells and Survival of Patients With Pancreatic Carcinoma Are Not Altered by Insulin Glargine

Erbel¹,

Reers²,

Eckstein³

et al. 2008

Diabetes Care

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OBJECTIVE -It was reported that the long-acting insulin analogue glargine induces cell proliferation in a human osteosarcoma cell line and therefore might induce or accelerate tumor growth. Induction of cell proliferation would be particularly relevant for insulin treatment of subjects with diabetes and the potential of bearing tumor cells (e.g., a history of a malignant disease).RESEARCH DESIGN AND METHODS -Proliferation, apoptosis, and the expression levels of insulin receptor, IGF-I receptor, and insulin receptor substrate (IRS) 2 were analyzed in human pancreatic cancer cells (Colo-357) after incubation (72 h) with insulin glargine or regular human insulin at 0 -100 nmol/l. A total of 125 subjects, after partial or total pancreatectomy due to pancreatic carcinoma, were analyzed over a median follow-up period of 22 months.RESULTS -There was no significant difference between glargine and regular human insulin with respect to regulation of proliferation and apoptosis of Colo-357 cells. The expression levels of insulin receptor, IGF-I receptor, and IRS2 as a downstream molecule of both receptor signaling pathways were not altered at any concentration tested. The insulin receptor was downregulated to a similar degree by glargine and regular human insulin at high insulin concentrations (P Ͻ 0.0001 for glargine, P ϭ 0.002 for regular human insulin). The median survival time after pancreatic surgery was 15 months. Survival analysis showed that the time-dependent proportion of patients who survived was identical in patients receiving insulin glargine versus insulin treatment without glargine and control subjects without diabetes after surgery (P ϭ 0.4, threesample comparison).CONCLUSIONS -Regular human insulin and insulin glargine may be used to treat diabetes in patients with pancreatic cancer.

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Comparison of Insulin Glargine Versus NPH Insulin in People with Type 2 Diabetes Mellitus Under Outpatient-Clinic Conditions for 18 Months Using a Basal-Bolus Regimen with a Rapid-Acting Insulin Analogue as Mealtime Insulin

Cited by 24 publications

References 12 publications

Long-Acting Insulin Analogs: A Review of “Real-World” Effectiveness in Patients with Type 2 Diabetes

Long-Acting Insulin Analogs: A Review of “Real-World” Effectiveness in Patients with Type 2 Diabetes

Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence

Proliferation of Colo-357 Pancreatic Carcinoma Cells and Survival of Patients With Pancreatic Carcinoma Are Not Altered by Insulin Glargine

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Comparison of Insulin Glargine Versus NPH Insulin in People with Type 2 Diabetes Mellitus Under Outpatient-Clinic Conditions for 18 Months Using a Basal-Bolus Regimen with a Rapid-Acting Insulin Analogue as Mealtime Insulin

Cited by 24 publications

References 12 publications

Long-Acting Insulin Analogs: A Review of &#x201C;Real-World&#x201D; Effectiveness in Patients with Type 2 Diabetes

Long-Acting Insulin Analogs: A Review of &#x201C;Real-World&#x201D; Effectiveness in Patients with Type 2 Diabetes

Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence

Proliferation of Colo-357 Pancreatic Carcinoma Cells and Survival of Patients With Pancreatic Carcinoma Are Not Altered by Insulin Glargine

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Long-Acting Insulin Analogs: A Review of “Real-World” Effectiveness in Patients with Type 2 Diabetes

Long-Acting Insulin Analogs: A Review of “Real-World” Effectiveness in Patients with Type 2 Diabetes