Vnitr Lek 2007, 53(6):632-636

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

I. Haladová^*, S. Lacigová, Z. Jankovec, D. Čechurová, M. Žourek, M. Krčma, Z. Rušavý

Diabetologické centrum I. interní kliniky Lékařské fakulty UK a FN Plzeň, přednosta doc. MUDr. Martin Matějovič, Ph.D.

Objective:
To assess the experience obtained by a diabetes centre in the treatment of patients with type 1 diabetes with the long-term 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.

Keywords: diabetes mellitus; Lantus; insulin; glargin

Received: June 7, 2006; Accepted: January 9, 2007; Published: June 1, 2007  Show citation