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Basal insulin treatment in type 2 diabetes
Maka S Hedrington1, Lindsay Pulliam, Stephen N Davis
1Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
Diabetes Technology & Therapeutics
|June 15, 2011
Summary
Insulin glargine, a long-acting insulin analog, effectively lowers blood glucose and A1c in type 2 diabetes patients. It demonstrates a reduced risk of hypoglycemia compared to NPH insulin.
Area of Science:
- Endocrinology
- Pharmacology
- Metabolic Diseases
Background:
- Insulin glargine is a 24-hour recombinant DNA insulin analog.
- Its unique formulation creates microprecipitates, delaying absorption for a flat concentration profile.
- This formulation aims to improve glycemic control and reduce hypoglycemia risk.
Purpose of the Study:
- To evaluate the efficacy and safety of insulin glargine in patients with type 2 diabetes.
- To compare insulin glargine with NPH insulin, premixed analogs, insulin detemir, and GLP-1 agonists.
- To assess the impact on glycemic control (A1c, fasting blood glucose) and hypoglycemia rates.
Main Methods:
- Large, multicenter, randomized, controlled trials were conducted.
- Insulin glargine's effects were compared against NPH insulin, premixed analogs, insulin detemir, and glucagon-like peptide-1 agonists.
- Key outcomes included glycosylated hemoglobin (A1c), fasting blood glucose, and hypoglycemia incidence.
Main Results:
- Insulin glargine and NPH insulin showed equal efficacy in lowering A1c and fasting blood glucose.
- Insulin glargine significantly reduced nocturnal and overall hypoglycemia compared to NPH insulin.
- Comparisons with premixed analogs showed greater A1c reduction with premixed insulins when glargine was used without mealtime coverage.
- Insulin glargine and insulin detemir demonstrated comparable efficacy and hypoglycemia risk.
- Insulin glargine and GLP-1 agonists showed similar A1c reductions.
Conclusions:
- Insulin glargine is an effective treatment for type 2 diabetes, offering comparable glycemic control to NPH insulin but with a lower risk of hypoglycemia.
- It presents a favorable safety profile, including low immunogenicity and reduced risks of acute myocardial infarction.
- Insulin glargine provides a valuable therapeutic option for managing type 2 diabetes, particularly for patients concerned about hypoglycemia.
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