Long-Acting Insulin Safe for Type 2 Diabetes

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: Diabetes Care, Reuters Health, February 2005.)