Long-Acting Insulin Safe for Type
2 Diabetes
February 9, 2005
When patients with type 2 diabetes that is no longer
controlled with oral medications begin insulin therapy,
it is better to add once-daily glargine insulin to the
oral regimen than to switch to a shorter-acting insulin
that needs to be injected twice a day, according to
a report in the journal Diabetes Care.
There is currently no consensus on how and when insulin
therapy should be started in type 2 diabetic patients,
the authors explain, and treatment regimens vary from
place to place.
Unlike type 1 diabetes, previously referred to as juvenile-onset
diabetes, which is a more severe disease, type 2 diabetes
primarily develops in adults, begins gradually, progresses
slowly and is often effectively controlled with oral
medications.
Dr. Hans U. Janka from Zentralkrankenhaus in Bremen-Nord,
Germany, and colleagues compared two commonly used regimens
for initiating insulin therapy: adding once-daily glargine
insulin to oral antidiabetic therapy, or replacing oral
antidiabetic therapy with twice-daily shorter-acting
insulin.
The study group included 364 type 2 diabetes who had
never been treated with insulin. The patients were randomly
assigned to one of the two treatment groups.
The improvement in glycosylated hemoglobin, a measure
of glucose control, over the 24-week study was greater
with glargine plus oral therapy than with shorter-acting
insulin, the authors report.
Similarly, fasting blood glucose and average daily
glucose levels showed significantly greater improvement
with glargine plus oral therapy compared with treatment
with shorter-acting insulin, the report indicates. Moreover,
the researchers note, fewer glargine plus oral therapy
patients experienced episodes of low blood sugar.
A similar number of adverse events was experienced
by patients in the two treatment groups.
These findings show that for type 2 diabetes patients
with poor control over blood sugar with oral therapy
alone, the addition of a single injection of insulin
glargine to oral medications can provide more effective
glycemic control than switching from oral medications
to twice-daily insulin injections, the authors conclude.
"The glargine plus oral antidiabetic therapy 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," the investigators add.
Source:http://today.reuters.co.uk
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