Insulin glargine versus NPH insulin in patients with type 1 diabetes

Type 1 diabetes is associated with a number of diabetes-related complications which may be minimized by maintaining good long-term metabolic control. The current guidelines recommend that glycosylated hemoglobin levels should be targeted to below 7.0% or 6.5% to reduce the incidence of diabetic complications, including micro- and macrovascular disorders. However, this intensive metabolic control is hindered by the occurrence of hypoglycemia. The episodes of hypoglycemia are problematic for patients taking intermediate-acting insulin preparations (i.e., NPH insulin), which have traditionally formed the mainstay basal insulin treatment. With NPH insulin, the pharmacokinetic profile is such that peak insulin activity occurs 4-6 hours following administration; therefore, nocturnal hypoglycemia commonly takes place after bedtime administration of the insulin. The development of the long-acting human insulin analogue insulin glargine now provides patients with an insulin that offers a longer duration of action (up to 24 hours) and a smoother time-action profile compared with those of NPH insulin. A number of clinical trials comparing the safety and efficacy of insulin glargine and NPH insulin in patients with type 1 diabetes show that, in addition to other clinical benefits over NPH insulin, insulin glargine may also improve glycemic control and satisfaction in this patient population.