Initiation of Insulin Glargine Therapy in Type 2 Diabetes Subjects Suboptimally Controlled on Oral Antidiabetic Agents: Results from the At. Lantus Trial
Resource
DIABETES, OBESITY AND METABOLISM v.10 n.5 pp.387-399
Journal
Diabetes Obesity and Metabolism
Pages
387-399
Date Issued
2008
Date
2008
Author(s)
Davies, M.
Lavalle-Gonzalez, F.
Storms, F.
Gomis, R.
Abstract
Objective: For many patients with type 2 diabetes, oral antidiabetic agents (OADs) do not provide optimal glycaemic control, necessitating insulin therapy. Fear of hypoglycaemia is a major barrier to initiating insulin therapy. The AT.LANTUS study investigated optimal methods to initiate and maintain insulin glargine (LANTUS Sanofi- aventis, Paris, France) therapy using two treatment algorithms. This subgroup analysis investigated the initiation of once-daily glargine therapy in patients suboptimally controlled on multiple OADs. Research Design and Methods: This study was a 24-week, multinational (59 countries), multicenter (611), randomized study. Algorithm 1 was a clinic-driven titration and algorithm 2 was a patient -driven titration. Titration was based on target fasting blood glucose Algorithms were compared for incidence of severe hypoglycaemia[requiring assistance and blood glucose< 50 mg/dl (<2.8 mmol/ l)] and baseline to end-point change in haemoglobin A1c (HbA1c). Results: Of the 4961 patients enrolled in the study, 865 were included in this subgroup analysis: 340 received glargine plus 1 OAD and 525 received glargine plus >1 OAD. Incidence of severe hypoglycaemia was< 1%. HbA1c decreased significantly between baseline and end- point for patients receiving glargine plus 1 OAD ( 1 plus > 1 OAD ( vs. algorithm 2 Conclusions: This study shows that initiation of once-daily glargine with OADs results in significant reduction of HbA1c with a low risk of hypoglycaemia. The greater reduction in HbA1c was seen in patients randomized to the patient-driven algorithm ( algorithm 2) on 1 or >1 OAD.
Subjects
basal insulin analogues
insulin glargine
oral antidiabetic agents
titration
type 2 diabetes
treatment algorithms
SDGs
Type
journal article