Efficacy of conversion from bedtime NPH insulin to morning insulin glargine in type 2 diabetic patients on basal-prandial insulin therapy

Yokoyama, Hiroyuki; Tada, J; Kamikawa, Futayo; Kanno, Sakiko; Yokota, Yuki; Kuramitsu, Masae

doi:10.1016/j.diabres.2005.12.009

Cited by 46 publications

(30 citation statements)

References 20 publications

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“…In addition, changes in body weight were neither statistically nor clinically significant. This result is in concordance with the findings in randomized clinical trials [2,5,14,23]. The neutral effect of glargine on body weight in this study may be due to increased self-care behaviors, improvement in lifestyle and nutritional status of the participants [24] suggesting that insulin glargine may be more beneficial in treating obese patients with T2DM [25].…”

Section: Discussionsupporting

confidence: 82%

“…If lifestyle intervention and intensive treatment with oral lowering glucose drugs (OGLDs) fail to achieve the targeted HbA1c levels, basal insulin therapy is recommended [13]. Newer insulin therapies such as different types of insulin analogues trying to simulate the physiologic basal-prandial insulin have changed clinical diabetes care [14,15]. Insulin glargine (LANTUS; Sanofi-Aventis, Paris, France) is a basal insulin analogue with no pronounced peak, consistent activity profile [16], and lower risk of nocturnal hypoglycemia compared with neutral protamine Hagedorn (NPH) insulin in patients with T2DM [2].…”

Section: Introductionmentioning

confidence: 99%

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Practical Focus on American Diabetes Association/European Association for the Study of Diabetes Consensus Algorithm in Patients with Type 2 Diabetes Mellitus: Timely Insulin Initiation and Titration (Iran-AFECT)

et al. 2017

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Background:The aim of this study was to evaluate the safety and effectiveness of insulin glargine in a large population from a variety of clinical care in Iranian people with type 2 diabetes mellitus (T2DM) and to measure the percentage of patients achieving glycosylated hemoglobin (HbA1c) <7% by the end of 24 weeks of treatment in routine clinical practice. Methods: This study was a 24 week, observational study of patients with T2DM, for whom the physician had decided to initiate or to switch to insulin glargine. The safety and efficacy of glargine were assessed at baseline and at week 24. Results: Seven hundred and twenty-five people with T2DM (63% female) including both insulin naïve and prior insulin users were recruited in this study. The mean age of the participants was 54.2±11.2 years, and the mean HbA1c level was 8.88%±0.93% at baseline. By the end of the study, 27% of the entire participants reached to HbA1c target of less than 7% and 52% had HbA1c ≤7.5%. No serious adverse event was reported in this study. Furthermore, overall hypoglycemia did not increase in prior insulin users and the entire cohort. In addition, body weight did not change in participants while lipid profile improved significantly. Conclusion: Treatment with insulin glargine could improve glycemic control without increasing the risk of hypoglycemic events in people with T2DM. In addition, a significant clinical improvement was observed in lipid profile.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Practical Focus on American Diabetes Association/European Association for the Study of Diabetes Consensus Algorithm in Patients with Type 2 Diabetes Mellitus: Timely Insulin Initiation and Titration (Iran-AFECT)

et al. 2017

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“…In total, 4,091 and 1,086 glargine-and detemirtreated individuals, respectively, were included in the analysis. Individuals were non-insulin-treated subjects except in one study, 41 where participants who were receiving a rapidacting insulin analog plus NPH either continued their treatment or had the NPH replaced with glargine. The treatment period was 24 weeks or more in all but one study for detemir, 42 where the study duration was 20 weeks.…”

Section: Summary Of Analyzed Studiesmentioning

confidence: 99%

Relationship of Insulin Dose, A1c Lowering, and Weight in Type 2 Diabetes: Comparing Insulin Glargine and Insulin Detemir

Dailey

Admane

Mercier³

et al. 2010

Diabetes Technology & Therapeutics

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Background: A pooled analysis of randomized controlled trials of individuals with type 2 diabetes mellitus (T2DM) was conducted to compare dosing and impact of two basal insulin analogs, insulin glargine (glargine) and insulin detemir (detemir), on weight and hemoglobin A1c (A1c). Methods: Twenty-two studies of at least 20 weeks in duration in individuals with T2DM initiating glargine/ detemir were included. Results were combined using a weighted-average method and a bivariate random effect model. Outcomes included changes in weight, A1c, and insulin dose from study start to end. Results: One study was head-to-head comparison of glargine and detemir. Detemir (four studies) was administered once or twice daily, with 50% starting on detemir once daily but needing therapy intensification. Glargine was used once daily in all 22 studies. The Egger test was borderline significant for change in weight over the course of the treatment for glargine (0.29; 90% confidence interval [CI] À0.01, 0.58), and heterogeneity was not observed for detemir (À0.18; 90% CI À0.59, 0.23). Heterogeneity was observed for change in A1c over the course of the treatment (glargine, À1.19, 90% CI À1.74, À0.63; detemir, À2.65, 90% CI À4.86, À0.45). Nonheterogeneity for change in A1c over the course of the treatment was achieved by excluding five studies for glargine and one study for detemir; however, all studies were included in subsequent analyses. In the unadjusted model, glargine and detemir showed similar results for mean A1c change (À1.4% vs. À1.4%), weight gain (2.5 vs. 1.7 kg), and weight/A1c (1.8 vs. 1.2 kg/%). A significantly higher detemir dose was needed to achieve the same A1c change (51.5 vs. 38.8 U/day). Conclusions: Although absolute weight gain was higher with glargine versus detemir, weight gain per A1c change was similar. A higher detemir dose was required to achieve a similar A1c reduction.

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“…Já Yokama e cols. não observaram diferença significativa nos níveis de A1c em pacientes diabéticos tipo 2, usuários prévios de insulina NPH noturna, que receberam insulina glargina matinal 1 x dia (19).…”

Section: Discussionunclassified

“…Após ( basal (glargina), sem alteração significativa da dose total diária de insulina após a substituição da insulina NPH, para se atingir os níveis glicêmicos ideais, sem alteração dos índices de hipoglicemias (19). Já em pacientes com DM2 usuários de terapia de bomba de insulina (TBI), que passaram a utilizar insulina glargina como basal, observa-se redução semelhante da A1c, sem diferença entre os grupos (TBI vs. glargina), achados equivalentes para ganho de peso, hipoglicemias e satisfação com o tratamento (20).…”

Section: Antesunclassified

Substituição da insulina NPH por insulina glargina em uma coorte de pacientes diabéticos: estudo observacional

Maia

Melo

Araujo

et al. 2007

Arq Bras Endocrinol Metab

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RESUMOEste estudo avaliou o impacto da introdução da insulina glargina na terapia basal/bólus em pacientes com diabetes mellitus do tipo 1 (DM1) e do tipo 2 (DM2), com controle inadequado (A1c > 6,9%) em uso prévio de insulina basal NPH. Foi realizado um estudo retrospectivo, não-controlado, com 49 pacientes (28F/21M), idade média 24,7 ± 16,5 anos, tempo de diabetes de 13,2 ± 10,1, sendo 93,1% dos pacientes com DM1, que receberam insulina glargina combinada com insulina ultra-rápida (aspart/lispro) pré-refeições, durante 90 dias de seguimento. Foram analisados dose total de insulina, incidência de hipoglicemias, crises convulsivas, complicações hiperglicêmicas (cetoacidose) e níveis de A1c antes e após três meses do uso da insulina glargina. Os valores de A1c foram determinados pelo método HPLC, com valores de referência de 4,3% a 6,9%. Após 3 meses da modificação do esquema basal para insulina glargina, observou-se redução significativa dos níveis de A1c (10,2 ± 2,0 vs. 9,1 ± 1,8%; p= 0,019). Além disso, verificou-se redução de 0,11 U/kg/dia na dose total de insulina utilizada (NPH: 0,75 U/kg para 0,64 U/kg de insulina glargina; p< 0,05). O uso da insulina glargina associou-se com redução das crises hipoglicêmicas (p= 0,02), crises convulsivas por hipoglicemia grave (p= 0,023) e nenhum caso de cetoacidose (p= 0,001). Este estudo corrobora a eficácia da introdução da insulina glargina em pacientes diabéticos mal controlados, em uso prévio de insulina NPH, com redução importante dos níveis de A1c. Estima-se uma melhora da qualidade de vida desses pacientes, marcada pela redução de eventos hipoglicêmicos (inclusive os graves), episódios de cetoacidose e utilização de menor dose diária de insulina, com provável impacto em políticas de saúde pública. ABSTRACTSwitching of NPH Insulin to Glargine Therapy in a Cohort of Poorly Controlled Diabetic Patients: Observational Study. This study examined the impact of insulin glargine introduction in basal-bolus therapy in type 1 and type 2 diabetic patients with inadequate metabolic control (A1c > 6.9%) using previous NPH insulin regime. In this uncontrolled, retrospective study, 49 patients (28F/21M), average age 24.7 ± 16.5, mean duration of DM 13.2 ± 10.1 yrs., 93.1% DM1 patients, received insulin glargine plus mealtime rapid-acting insulin (lispro or aspart) followed by 90-day treatment. We analyzed mean total insulin dose, incidence of hypoglycemic events, convulsive crisis, hyperglycemic complications and A1c levels before and after three months of introduction of glargine therapy. A1c values were determined using the HPLC instrument, with a normal range of 4.3% to 6.9%. After switching to insulin glargine therapy, mean A1c dropped from 10.2 ± 2.0 to 9.1 ± 1.8%, with significant impact (p= 0.019). We observed a significant reduction of 0.11U/kg/day in total insulin dose, dropped from 0.75U/kg of NPH to 0.64U/kg of glargine, with significant correlation (p< 0.05). The introduction of glargine therapy was coincident with a decrease of hypoglycemic crisis (p= 0.02), convu...

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Efficacy of conversion from bedtime NPH insulin to morning insulin glargine in type 2 diabetic patients on basal-prandial insulin therapy

Cited by 46 publications

References 20 publications

Practical Focus on American Diabetes Association/European Association for the Study of Diabetes Consensus Algorithm in Patients with Type 2 Diabetes Mellitus: Timely Insulin Initiation and Titration (Iran-AFECT)

Practical Focus on American Diabetes Association/European Association for the Study of Diabetes Consensus Algorithm in Patients with Type 2 Diabetes Mellitus: Timely Insulin Initiation and Titration (Iran-AFECT)

Relationship of Insulin Dose, A1c Lowering, and Weight in Type 2 Diabetes: Comparing Insulin Glargine and Insulin Detemir

Substituição da insulina NPH por insulina glargina em uma coorte de pacientes diabéticos: estudo observacional

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