Less hypoglycemia with insulin glargine in intensive insulin therapy for type 1 diabetes. U.S. Study Group of Insulin Glargine in Type 1 Diabetes.

Abstract

OBJECTIVE: Insulin glargine (21A-Gly-30Ba-L-Arg-30Bb-L-Arg-human insulin) is a biosynthetic insulin analog with a prolonged duration of action compared with NPH human insulin. This study compared insulin glargine with NPH human insulin in subjects with type 1 diabetes who had been previously treated with multiple daily injections of NPH insulin and regular insulin. RESEARCH DESIGN AND METHODS: This study was a multicenter randomized parallel-group study in which subjects were randomized to receive premeal regular insulin and either insulin glargine (at bedtime) or NPH insulin (at bedtime for patients on once-daily therapy and at bedtime and in the morning for patients on twice-daily therapy) for up to 28 weeks. Dose titration of both basal insulins was based on capillary fasting whole blood glucose (FBG) levels; the goal was a premeal blood glucose concentration of 4.4-6.7 mmol/l. RESULTS: A total of 534 well-controlled type 1 diabetic subjects (mean GHb 7.7%, mean fasting plasma glucose [FPG] 11.8 mmo/l) were treated. A small decrease in GHb levels was noted with both insulin glargine (-0.16%) and NPH insulin (-0.21%; P > 0.05). Significant reductions in median FPG levels from baseline (-1.67 vs. -0.33 mmol/l with NPH insulin, P = 0.0145) and a trend for a reduction in capillary FBG levels were achieved with insulin glargine. After the 1-month titration phase, significantly fewer subjects receiving insulin glargine experienced symptomatic hypoglycemia (39.9 vs. 49.2%, P = 0.0219) or nocturnal hypoglycemia (18.2 vs. 27.1%, P = 0.0116) with a blood glucose level <2.0 mmol/l compared with subjects receiving NPH insulin. CONCLUSIONS: Lower FPG levels with fewer episodes of hypoglycemia were achieved with insulin glargine compared with once- or twice-daily NPH insulin as part of a basal-bolus regimen in patients with type 1 diabetes.

Comparison of insulin detemir and insulin glargine in a basal—bolus regimen, with insulin aspart as the mealtime insulin, in patients with type 1 diabetes: A 52-week, multinational, randomized, open-label, parallel-group, Treat-to-Target noninferiority trial

“…Despite the reductions in HbA 1c , the mean rate of hypoglycemic episodes decreased throughout the trial in both groups. These results are consistent with findings from previous studies comparing detemir 17,18 and glargine 19 with NPH insulin in T1DM, 17 in which basal-bolus therapy with either insulin analogue was associated with improved tolerability (reduced risk of hypoglycemia) at comparable levels of glycemic control.…”

Use of Insulin Glargine in Japanese Patients with Type 1 Diabetes

“…This value is lower than the value reported for Type 1 diabetes patients from other countries (4,5,13 (14), while the fat content of the diet is correlated with the insulin resistance in patients with Type 1 diabetes (13).…”

Place of insulin therapy in current approaches to the treatment of type 2 diabetes

“…Полученный инсулин имеет стабильную структуру, растворимую в кислой среде при рН 4, и при введении под кожу образовывает микропреципитаты с нейтраль-ным значением рН, что обеспечивает замедление всасы-вания [16]. Клинические исследования подтвердили, что по сравнению с НПХ-инсулином он имеет большую дли-тельность действия (до 24 ч), меньшую вариабельность и постоянство эффекта, а также низкий риск гипогликемий, связанный с беспиковым профилем действия [17,18]. Важно, что инсулин гларгин обеспечивает базальный кон-троль гликемии независимо от времени введения (утром или перед сном) и места введения (подкожная клетчатка плеч, бедер или живота) без необходимости ресуспензи-рования для равномерного распределения частиц.…”