PMID- 17697063
OWN - NLM
STAT- MEDLINE
DCOM- 20071214
LR  - 20161124
IS  - 1462-8902 (Print)
IS  - 1462-8902 (Linking)
VI  - 9
IP  - 5
DP  - 2007 Sep
TI  - Initiation of insulin glargine in suboptimally controlled patients with type 2 
      diabetes: sub-analysis of the AT.LANTUS trial comparing treatment outcomes in 
      subjects from primary and secondary care in the UK.
PG  - 706-13
AB  - AIM: The AT.LANTUS study compared insulin glargine initiation and titration using 
      one of two algorithms in suboptimally controlled subjects with type 2 diabetes 
      mellitus (T2DM) based on a primary outcome of severe hypoglycaemia. Secondary 
      outcomes included other categories of hypoglycaemia, glycaemic control, weight 
      changes and insulin dose. Here, we report the results of a subanalysis of the 
      trial, which investigated whether insulin glargine can be initiated and titrated 
      as effectively in primary [general practitioner (GP)] as secondary (hospital) 
      care in patients with T2DM in the UK. METHODS: The main study was a multicentre 
      (n = 611), multinational (n = 59), open-label, 24-week randomized trial in 4,588 
      suboptimally controlled subjects with T2DM. Insulin glargine was titrated to 
      target fasting blood glucose (FBG) levels of <or=5.5 mmol/l according to 
      algorithm 1 (clinic-driven titration) or algorithm 2 (patient-managed titration). 
      In this substudy, 819 subjects (GP, n = 215; hospital, n = 604) from 57 primary 
      and 130 secondary care centres were included in the subanalysis; subjects were 
      switched to once-daily insulin glargine from baseline treatments that consisted 
      primarily of oral antidiabetic agents (OADs) (38%) only or premixed insulin +/- 
      OAD (23%). RESULTS: Both the GP and the hospital groups of subjects experienced a 
      low incidence of severe hypoglycaemia (<1%), with significant decreases in HbA1c 
      levels (-0.51 and -0.95% respectively; p < 0.001), large reductions in FBG levels 
      (-2.72 and 3.0 mmol/l respectively; p < 0.001) and modest weight gain of 1 and 
      1.2 kg respectively (p < 0.05). With the exception of absolute reductions in 
      HbA1c and reductions in basal and prandial insulin made on switching to insulin 
      glargine, there were few significant differences in subjects managed in primary 
      compared with secondary care. CONCLUSIONS: This study shows that despite 
      differences in diabetes duration and baseline glycaemic control, an insulin 
      glargine-based therapy can be safely and effectively initiated in a diverse range 
      of suboptimally controlled subjects with T2DM in both primary and secondary care 
      settings in the UK. Rates of hypoglycaemia were low and consistent with the 
      results of the main study. Absolute reductions in HbA1c were greatest in the 
      secondary care setting, but similar levels of glycaemic control were achieved in 
      both groups due to differences in baseline HbA1c. In the patients managed in 
      primary care, there was an overall reduction in prandial and basal insulin used 
      when switching to a basal insulin regimen and a lack of titration of prandial 
      insulin. Therefore, the role of prandial insulin, its initiation and titration, 
      appears to be an area that requires more focus in primary care.
FAU - Davies, M
AU  - Davies M
AD  - Department of Cardiovascular Sciences, University of Leicester, Leicester, UK. 
      melanie.davies@uhl-tr.nhs.uk
FAU - Evans, R
AU  - Evans R
FAU - Storms, F
AU  - Storms F
FAU - Gomis, R
AU  - Gomis R
FAU - Khunti, K
AU  - Khunti K
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Diabetes Obes Metab
JT  - Diabetes, obesity & metabolism
JID - 100883645
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 0 (Insulin, Long-Acting)
RN  - 2ZM8CX04RZ (Insulin Glargine)
SB  - IM
MH  - Algorithms
MH  - Diabetes Mellitus, Type 2/*drug therapy/epidemiology/metabolism
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Humans
MH  - Hypoglycemic Agents/pharmacology/*therapeutic use
MH  - Insulin/*analogs & derivatives/pharmacology/therapeutic use
MH  - Insulin Glargine
MH  - Insulin, Long-Acting
MH  - Male
MH  - Middle Aged
MH  - Primary Health Care/standards
MH  - Titrimetry
MH  - Treatment Outcome
MH  - United Kingdom/epidemiology
EDAT- 2007/08/19 09:00
MHDA- 2007/12/15 09:00
CRDT- 2007/08/19 09:00
PHST- 2007/08/19 09:00 [pubmed]
PHST- 2007/12/15 09:00 [medline]
PHST- 2007/08/19 09:00 [entrez]
AID - DOM652 [pii]
AID - 10.1111/j.1463-1326.2006.00652.x [doi]
PST - ppublish
SO  - Diabetes Obes Metab. 2007 Sep;9(5):706-13. doi: 10.1111/j.1463-1326.2006.00652.x.