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Modulation of insulin dose titration using a hypoglycaemia-sensitive algorithm: insulin glargine versus neutral protamine Hagedorn insulin in insulin-naïve people with type 2 diabetes.

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Modulation of insulin dose titration using a hypoglycaemia-sensitive algorithm: insulin glargine versus neutral protamine Hagedorn insulin in insulin-naïve people with type 2 diabetes.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Home, P. D. Bolli, G. B. Mathieu, C. Deerochanawong, C. Landgraf, W. Candelas, C. Pilorget, V. Dain, M-P Riddle, M. C.
Spatial Coverage	Europe Middle East Asia South Africa
Description	Country affiliation: United kingdom Author Affiliation: Home PD ( Institute for Cellular Medicine - Diabetes, Newcastle University, Newcastle upon Tyne, UK.)
Abstract	AIMS: To examine whether insulin glargine can lead to better control of glycated haemoglobin (HbA1c) than that achieved by neutral protamine Hagedorn (NPH) insulin, using a protocol designed to limit nocturnal hypoglycaemia. METHODS: The present study, the Least One Oral Antidiabetic Drug Treatment (LANCELOT) Study, was a 36-week, randomized, open-label, parallel-arm study conducted in Europe, Asia, the Middle East and South America. Participants were randomized (1:1) to begin glargine or NPH, on background of metformin with glimepiride. Weekly insulin titration aimed to achieve median prebreakfast and nocturnal plasma glucose levels ≤5.5 mmol/l, while limiting values ≤4.4 mmol/l. RESULTS: The efficacy population (n = 701) had a mean age of 57 years, a mean body mass index of 29.8 kg/m², a mean duration of diabetes of 9.2 years and a mean HbA1c level of 8.2% (66 mmol/mol). At treatment end, HbA1c values and the proportion of participants with HbA1c <7.0 % (<53 mmol/mol) were not significantly different for glargine [7.1 % (54 mmol/mol) and 50.3%] versus NPH [7.2 % (55 mmol/mol) and 44.3%]. The rate of symptomatic nocturnal hypoglycaemia, confirmed by plasma glucose ≤3.9 or ≤3.1 mmol/l, was 29 and 48% less with glargine than with NPH insulin. Other outcomes were similar between the groups. CONCLUSION: Insulin glargine was not superior to NPH insulin in improving glycaemic control. The insulin dosing algorithm was not sufficient to equalize nocturnal hypoglycaemia between the two insulins. This study confirms, in a globally heterogeneous population, the reduction achieved in nocturnal hypoglycaemia while attaining good glycaemic control with insulin glargine compared with NPH, even when titrating basal insulin to prevent nocturnal hypoglycaemia rather than treating according to normal fasting glucose levels.
File Format	HTM / HTML
ISSN	14628902
e-ISSN	14631326
DOI	10.1111/dom.12329
Journal	Diabetes, Obesity and Metabolism
Issue Number	1
Volume Number	17
Language	English
Publisher	Wiley-Blackwell
Publisher Date	2015-01-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Metabolism Discipline Endocrinology Discipline Pharmacology Discipline Diabetology Diabetes Mellitus, Type 2 Drug Therapy Drug Resistance Hyperglycemia Prevention & Control Hypoglycemia Hypoglycemic Agents Administration & Dosage Insulin, Isophane Insulin, Long-acting Blood Glucose Self-monitoring Circadian Rhythm Blood Drug Dosage Calculations Drug Therapy, Combination Adverse Effects Hemoglobin A, Glycosylated Chemically Induced Therapeutic Use Insulin Glargine Metformin Middle East Sulfonylurea Compounds Comparative Study Multicenter Study Randomized Controlled Trial Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Endocrinology, Diabetes and Metabolism Internal Medicine Endocrinology

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Modulation of insulin dose titration using a hypoglycaemia-sensitive algorithm: insulin glargine versus neutral protamine Hagedorn insulin in insulin-naïve people with type 2 diabetes.

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