Twenty-Four Hour Action of Insulin Glargine (Lantus) May Be too Short for Once-Daily Dosing: A case report

Clement, Stephen; Bowen-Wright, Hazel E.

doi:10.2337/diacare.25.8.1479-a

Cited by 23 publications

(25 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…18 However, twice-daily use of insulin glargine might be required to achieve therapeutic goals in some patients with T2DM. 19 Other insulin therapy options, such as insulin detemir and insulin lispro protamine suspension, also have convenience and outcome benefits which may contribute to improved persistence and adherence. [20][21][22] In reality, patients taking insulin glargine have been shown to be more likely to persist with their medication than those taking NPH insulin.…”

Section: Introductionmentioning

confidence: 99%

Real-world outcomes of US employees with type 2 diabetes mellitus treated with insulin glargine or neutral protamine Hagedorn insulin: a comparative retrospective database study

et al. 2013

View full text Add to dashboard Cite

ObjectivesTo compare real-world outcomes of initiating insulin glargine (GLA) versus neutral protamine Hagedorn (NPH) insulin among employees with type 2 diabetes mellitus (T2DM) who had both employer-sponsored health insurance and short-tem-disability coverages.DesignRetrospective cohort study.SettingMarketScan Commercial Claims and Encounters/Health and Productivity Management Databases 2003–2009.ParticipantsAdult employees with T2DM who were previously treated with oral antidiabetic drugs and/or glucagon-like-peptide 1 receptor agonists and initiated GLA or NPH were included if they were continuously enrolled in healthcare and short-term-disability coverages for 3 months before (baseline) and 1 year after (follow-up) initiation. Treatment selection bias was addressed by 2:1 propensity score matching. Sensitivity analyses were conducted using different matching ratios.Primary and secondary outcome measuresOutcomes during 1-year follow-up were measured and compared: insulin treatment persistence and adherence; hypoglycaemia rates and daily average consumption of insulin; total and diabetes-specific healthcare resource utilisation and costs and loss in productivity, as measured by short-term disability, and the associated costs.ResultsA total of 534 patients were matched and analysed (GLA: 356; NPH 178) with no significant differences in baseline characteristics. GLA patients were more persistent and adherent (both p<0.05), had lower rates of hospitalisation (23% vs 31.4%; p=0.036) and endocrinologist visits (19.1% vs 26.9%; p=0.038), similar hypoglycaemia rates (both 4.4%; p=1.0), higher diabetes drug costs ($2031 vs $1522; p<0.001), but similar total healthcare costs ($14 550 vs $16 093; p=0.448) and total diabetes-related healthcare costs ($4686 vs $5604; p=0.416). Short-term disability days and costs were numerically lower in the GLA cohort (16.0 vs 24.5 days; p=0.086 and $2824 vs $4363; p=0.081, respectively). Sensitivity analyses yielded similar findings.ConclusionsInsulin GLA results in better persistence and adherence, compared with NPH insulin, with no overall cost disadvantages. Better persistence and adherence may lead to long-term health benefits for employees with T2DM.

show abstract

Section: Introductionmentioning

confidence: 99%

Real-world outcomes of US employees with type 2 diabetes mellitus treated with insulin glargine or neutral protamine Hagedorn insulin: a comparative retrospective database study

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Given that the mean duration of action of therapeutic doses of the basal insulin analogs has been reported as close to (or, in some studies, slightly below 24 hours),35 at least some patients may benefit from their basal insulin being injected more frequently than once daily, as has been reported for insulin glargine 106,107. Therefore, the present author carried out a randomized comparative study (followed by an optional guideline-directed, nonrandomized, crossover phase) of once- versus twice-daily insulin detemir used as part of basal + bolus therapy in adult patients with type 1 diabetes 55.…”

Section: Clinical Efficacy and Safety Profile Of Insulin Detemirmentioning

confidence: 93%

Critical appraisal of the safety and efficacy of insulin detemir in glycemic control and cardiovascular risk management in diabetics

Floch¹

2010

DMSOTT

View full text Add to dashboard Cite

Insulin detemir is an analog of human insulin designed to provide a long duration of basal insulin action. This is achieved by protracted absorption from the injection depot, which results in part from increased self-association of insulin detemir molecules and in part from reversible albumin binding. Subsequent albumin binding in the circulation is thought to buffer changes in the effects at target tissues that could otherwise arise from variability in absorption rate. In consequence, insulin detemir has shown a less variable pharmacodynamic profile than alternative basal insulins; this manifests as more consistent temporal glucose reduction profiles in repeat-clamp studies. In clinical trials, insulin detemir has been characterized by consistent risk reductions in hypoglycemia, as well as reduced weight gain in comparison with other basal insulins. Given some recent associations that have been made in prospective and epidemiologic studies between glucose variability and/or hypoglycemia and increased cardiovascular risk, and the long-known association between excess weight and cardiovascular risk, it is possible that the clinical profile of insulin detemir may carry prognostic value with regard to cardiovascular safety, although this is yet to be substantiated. There have also been some concerns raised recently over the use of insulin analogs and cancer risk, but available clinical data and the receptor interaction profile of insulin detemir suggest no excess in risk in comparison with human insulin therapy. Optimal approaches for the clinical use of insulin detemir have been emerging through an increasing clinical study base, and the analog is becoming established as a potentially valuable therapy option.

show abstract

“…The duration of action can be 13 to over 24 hours, but the average is less than 24 hours. Because of this and the need for different basal rate levels during a 24 hour day, glargine is occasionally given twice a day in patients with type 1 diabetes [21].…”

Section: Basal Insulin Choicesmentioning

confidence: 99%

Basal Bolus Dosing: A Clinical Experience

King¹,

Armstrong²

2005

CDR

View full text Add to dashboard Cite

Basal bolus insulin dosing (BBD) may be defined as the physiological replacement of basal and bolus insulin to achieve near normal glycemia without hypoglycemia and loss of life quality. Normally, continuous and variable basal insulin release provides partial suppression of hepatic glucose production to maintain euglycemia during the fasting period. With meals, additional insulin is released in a biphasic pattern to further suppress hepatic glucose production and to increase glucose transport into muscle, fat and liver. Newer subcutaneous insulins for bolus and basal mimic near normal secretion. In addition, improvements in continuous subcutaneous insulin infusion pump features such as dual wave insulin delivery allow improved postprandial glycemia. Insulin dosing is done in a three step process. Firstly, the dosage is estimated based on formulas derived from body weight or previous insulin requirements. Secondly, pre-dosing adjustments modify these formulas by considering estimations of insulin sensitivity based on clinical judgment and laboratory evaluations. Lastly, post-dosage adjustments are based on timed, self-monitored, blood glucose determinations assisted by overall average glucose determinations such as hemoglobin A1c. Continuous glucose monitoring systems have provided a more insightful tool for dosage adjustments. Daily consecutive intensive glucose evaluations using a continuous glucose monitoring system and corresponding dosage adjustments may offer an even better tool for insulin dosing selection.

show abstract

Twenty-Four Hour Action of Insulin Glargine (Lantus) May Be too Short for Once-Daily Dosing: A case report

Cited by 23 publications

References 6 publications

Real-world outcomes of US employees with type 2 diabetes mellitus treated with insulin glargine or neutral protamine Hagedorn insulin: a comparative retrospective database study

Real-world outcomes of US employees with type 2 diabetes mellitus treated with insulin glargine or neutral protamine Hagedorn insulin: a comparative retrospective database study

Critical appraisal of the safety and efficacy of insulin detemir in glycemic control and cardiovascular risk management in diabetics

Basal Bolus Dosing: A Clinical Experience

Contact Info

Product

Resources

About