People prefer products that give them choices. This is
especially true for those with a lifelong illness that
necessitates the use of lifelong meds. Take diabetes for
example; insulin is a part of these patients' everyday
lives. There's no way around it, but a recent study in
Diabetes Care said that diabetic persons may have
more options when it comes to choosing what type of daily
injection they receive. Among the different kinds are
isophane (NPH) insulin and insulin glargine, both of which
have their own supporters. Insulin glargine, the new kid
on the block, can be used to treat type I diabetes, but
that's old news. A study just published in February has
come out in favour of glargine use for type II diabetes
as well.
ONCE
YOU GO GLARGINE
The study indicates that for people with type II diabetes
that's not well controlled with the standard retinue
of oral hypoglycemic drugs, adding a once-a-day shot
of insulin glargine is preferable to switching over
to the routine of twice daily injections using the traditional
NPH insulin/basal insulin combo. "The glargine plus
[oral antidiabetic] regimen in this study required only
a single daily injection and a single before-breakfast
glucose test to guide therapy and, therefore, should
be easy to use in clinical practice," said the authors.
Insulin glargine was approved for use in Canada in 2002
but was only recently released. Although its much-anticipated
arrival was delayed, it will hit the pharmacy shelves
soon.
The 24-week "multinational, multicentre,
open, parallel group clinical trial," headed by Dr Hans
U Janka of Zentralkrankenhaus in Bremen-Nord, Germany,
involved 371 patients who were not supplemented with
insulin and whose blood sugar control was erratic at
best. They were taking the oral antidiabetic combo of
sulfonylurea and metformin.
These patients were randomly picked
to receive a morning dose of glargine plus the oral
antidiabetics glimepiride and metformin, or twice daily
injections of a 30% regular/70% NPH insulin brew without
any oral antidiabetics. Patients were monitored for
the level of glycosylated hemoglobin (HbA1c), the benchmark
indicator of diabetes control.
The improvement in HbA1c levels
was more pronounced in those receiving the glargine-antidiabetic
combo than in those receiving NPH insulin. In addition,
46% of the patients in the former group reached HbA1c
levels of 7% or less, which is a signpost of excellent
longterm sugar control, as compared with only 29% of
the NPH insulin group.
SWEET
SUCCESS
And the good news continued. Fasting blood glucose and
mean daily glucose levels were significantly improved
in the patients receiving glargine. However, not everything
was sunshine and sugar-free lollipops; some patients
did become hypoglycemic. But, even then, significantly
fewer adverse effects were associated with glargine
(4.07/patient-year) than with NPH insulin (9.87/patient-year).
A report in a recent issue of the
same journal tipped the scale in favor of glargine for
type I diabetes as well and this latest report extends
the good news to type II diabetics. "The results show
that in patients with type II diabetes poorly controlled
on oral therapy, adding a single injection of insulin
glargine to glimepride and metformin can provide more
effective glycemic control than stopping [oral antidiabetics]
and starting twice-daily 70/30 insulin," the authors
concluded in the Diabetes Care paper.
Diabetes Care Feb 2005;28(2):254-9
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