Insulin glargine-based therapy improves glycemic control in patients with type 2 diabetes sub-optimally controlled onpremixed insulin therapies

The AT.LANTUS trial recently demonstrated the efficacy and safety of insulin glargineinitiation and maintenance using two different treatment algorithms in poorly controlledtype 2 diabetes mellitus (T2DM). This sub-analysis investigated glycemic control and safetyin 686 patients switching frompremixed insulin (premix) with or without (OADs) to oncedailyglargine (OADs/prandial insulin). A 24-week, multinational (n = 59), multicenter(n = 611), randomized study comparing two algorithms (Algorithm 1: clinic-driven titration;Algorithm 2: patient-driven titration) in four glargine  OADs treatment groups: alone,once- (OD), twice- (BD) or >twice- (>BD) daily prandial insulin. After switching to theglargine regimen, HbA1c levels significantly improved in the overall group (9.0  1.3 to8.0  1.2%; p < 0.001) and in all subgroups; fasting blood glucose levels also improved inall subgroups (overall: 167.1  50.0 to 106.9  27.2 mg/dL [9.3  2.8 to 5.9  1.5 mmol/L];p < 0.001). The incidence of severe hypoglycemia was also low in all four subgroups(1.7%). Patients with T2DM switching from premix  OADs to glargine  OADs had significantreductions in glycemic control with a low incidence of severe hypoglycemia. Theaddition of prandial (OD, BD or >BD) insulin was associated with further improvements inglycemic control.

These data provide support for the stepwise introduction of prandialinsulin to a more physiologic basal–bolus regimen, which is under investigation.