Reduced Severe Hypoglycemia with Insulin Glargine in Intensively Treated Adults with Type 1 Diabetes

Abstract

Background: The goal of new therapies introduced for type 1 diabetes should be to decrease hypoglycemic episodes while improving glycemic control.

Methods: A database was used to computer match the baseline A_1C values in 196 subjects with type 1 diabetes receiving multiple daily injections (MDI) consisting of four or more injections per day. There were 98 patients transferred from NPH to insulin glargine (Lantus^®, Aventis Pharmaceuticals, Bridgewater, NJ), and 98 patients remained on NPH throughout the study. The gender distribution and mean age (∼32 years), duration of diabetes (∼16 years), and duration of treatment (∼13 months) were not significantly different between the groups. The majority of patients were well controlled (>50% in both groups had an A_1c <7%).

Results: The mean A_1C values were not significantly different in the groups at baseline or at follow-up. Severe hypoglycemic episodes per patient per year were significantly lower in the glargine group compared with the NPH group (0.5 vs. 1.2, respectively; P = 0.04). The mean end-of-study total (P = 0.03) and long-acting (P = 0.0001) doses were significantly reduced from baseline in the group that switched to glargine, but not in the group that remained on NPH, with no change in the short-acting dose in either group. The weight gain was significantly higher in the NPH group at the end of the study (P = 0.004) with no significant change in the glargine group.

Conclusions: Transfer to glargine treatment from NPH in MDI regimens significantly reduces severe hypoglycemic episodes despite a decline in long-acting basal insulin without significant weight gain.