Clinical experience in treatment with the long-term insulin analogue glargin in a diabetes centre

Česká verzia

Authors: I. Haladová; S. Lacigová; Z. Jankovec; D. Čechurová; M. Žourek; M. Krčma; Z. Rušavý
Authors place of work: Diabetologické centrum I. interní kliniky Lékařské fakulty UK a FN Plzeň, přednosta doc. MUDr. Martin Matějovič, Ph. D.
Published in the journal: Vnitř Lék 2007; 53(6): 632-636
Category: Original Contributions

Summary

Objective:
To assess the experience obtained by a diabetes centre in the treatment of patients with type 1 diabetes with the longterm insulin analogue glargin.

Patient sample and method:
136 patients with type 1 diabetes mellitus (DM) were evaluated on a retrospective basis for the period from March 2004 to march 2005. We monitored HbA_1c before the treatment with glargin, after 3 months, again after 6 months, and finally after 1 year of therapy. We evaluated the effectiveness of treatment with glargin insulin based upon diabetes compensation at the start of treatment. We also compared glycaemia variability in the 6 months prior to treatment initiation and the 6 months after the application of glargin insulin, this was done using the standard glycaemia deviation obtained from the patients’ glucometers. In addition we evaluated the changes in total, basal and bolus daily dose of insulin after the change in therapy.

Results:
The results were evaluated in the form of a median and the percentile of 25 and 75. Before the glargin therapy started, HbA_1c was 7.4 (6.5–8.5) %. It decreased dramatically to 7.0 (6.2–8.1) % after 3 months of therapy (p < 0.01), to 7.2 (6.3–8.2) % after 6 months of therapy (p < 0.05), and reached the level of 7.1 (6.1–8.2) % after one year (p < 0.01). Analysis of glycemic profiles during the 6 months before and 6 months after transfer to glargin insulin therapy showed a significant decrease in the variability as evaluated by the decrease in standard deviations from the original 4.9 (4.3–5.6) mmol/l to 4.5 (3.9–5.1) mmol/l (p < 0.001). The total daily dose of insulin prior to treatment and after 6 months of therapy with glargin decreased from 44 (35–56) IU/day to 42 (34–53) IU/day (p = 0.01). There was no change in the basal dose of insulin after the change in therapy – it remained at 20 (12–28), (16–26) IU/day. The dose of bolus administered insulin decreased from 24 (18–32) to 21 (17–29) IU/day (p < 0.01).

Conclusion:
A dramatic improvement in HbA_1c and a dramatic decrease in glycaemia variability are associated with glargin insulin treatment. The dose of glargin insulin does not differ from that of NPH. Key words: diabetes mellitus – Lantus – insulin – glargin

Key words:
diabetes mellitus – Lantus – insulin – glargin

Zdroje

1. The United Kingdom prospective diabetes study. The Lancet 1998; 352: 837-865.

2. Donabauer B, Schneider K, Schweitzer MA. Introduction of insulin glargin to basal-bolus therapy improves metabolic control in patients with type 1 diabetes in every day clinical practice. Diabetologia 2005; Suppl 1.

3. Peter R, Luzio SD, Dunseath G et al. Effects of exercise on the absorption of insulin glargine in patients with type 1 diabetes. Diabetes Care 2005; 28: 560-565.

4. Chase HP et al. Reduced hypoglycemic episodes and improved glycaemic control in children with type 1 diabetes using insulin glargine and neutral protamine Hagedorn insulin. J Pediatr 2003; 143: 737-740.

5. Owens DR, Griffiths S. Insulin glargine (Lantus). Int J Clin Pract 2002; 56: 460-466.

6. Hamann A, Matthaei S, Rosak Ch et al. A randomized clinical trial comparing breakfast, dinner, or bedtime administration of insulin glargine in patients with type 1 diabetes. Diabetes Care 2003; 6: 1738-1744.

7. Witthaus E et al. Treatment satisfaction and psychological well-being with insulin glargine compared with NPH in patients with Type 1 diabetes. Diabet Med 2001; 18: 619-625.

8. Výbor České diabetologické společnosti ČLS JEP. Standardy péče o diabetes mellitus 1. typu. DMEV 2004; 1: 6-8.

9. Tan CY, Wilson DM, Buckingham B. Initiation of insulin glargine in children and adolescents with type 1 diabetes. Pediatric Diabetes 2004; 5: 80-86.

10. Hathout EH, Fujishige L, Geach J et al. Effect of therapy with insulin glargine (lantus) on glycemic control in toddlers, children, and adolescents with diabetes. Diabetes technology Therapeutics 2003; 5: 801-806.

11. Ashwell SG, Amiel SA, Biloust RW et al. Improved glycaemic control with insulin glargine plus insulin lispro: a multricentre, randomized, cross-over trial in people with Type 1 diabetes. Diabetes Med 2006; 23: 285-292.

12. Ratner R, Hirsch I, Neifing J et al. Less hypoglycemia with insulin glargine in intensive insulin therapy for type 1 diabetes. Diabetes Care 2000; 23: 639-643.

13. Colino E, Lopez-Capape M, Gomlmayo L et al. Therapy with insulin glargine (Lantus) in toddlers, children and adolescents with type 1 diabetes. Diabetes Res Clin Pract 2005; 70: 1-7.

14. Pickup J, Mattock M, Kerry S. Glycaemic control with continuous subcutaneous insulin infusion compared with intensive insulin injections in patients with type 1 diabetes: meta- analysis of randomised controlled trials. Br Med J 2002; 324: 705.

15. Jankovec Z, Krcma M, Lacigova S et al. National Registry of Patients Treated with Continuous Subcutaneous Insulin Infusion (CSII) in the Czech Republic: Long-term results. Infusystem International 2005; 4: 21-24.

16. Jankovec Z, Čechurová D, Krčma M et al. Dlouhodobý efekt léčby inzulínovou pumpou (CSII) - výsledky Registru pacientů léčených CSII v České republice. XLII. Diabetologické dny, Luhačovice, 20. - 22. 4. 2006. Diabetologie, Metabolismus, Endokrinologie, Výživa 2006; Suppl 2: 26.

17. The Diabetes Control and Complications Trial Research Group. The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the diabetes control and complications trial. Diabetes 1995; 44: 968-983.

18. Bartoš V, Pelikánová T et al. Praktická diabetologie. 2. ed. Praha: Maxdorf 2000; 88.

19. Meyer C, Grossmann R, Mitrakou A et al. Effects of autonomic neuropathy on counterregulation and awareness of hypoglycemia in type 1 diabetic patients. Diabetes Care 1998; 21: 1960-1966.

20. Hirsch IB, Brownlee M. Should minimal blood glucose variability become the gold standard of glycemic control? Diabetes Complications 2005; 19: 178-181.

21. Garg SK, Paul JM, Karsten JI et al. Reduced severe hypoglycemia with insulin glargine in intensively treated adults with type 1 diabetes. Diabetes technology Therapeutics 2004; 6: 589-595.

22. Ashwell SG, Gebbie H, Home PD Twice-daily compared with once-daily insulin glargine in people with Type 1 diabetes using meal-time insulin aspart. Diabet Med 2006; 23: 879-886.

23. Ashwell SG, Gebbie J, Home PD Optimal timing of injection of once- daily insulin glargine in people with Type 1 diabetes using insulin lispro at meal-times. Diabet Med 2006; 23: 46-52.