PMID- 19087105
OWN - NLM
STAT- MEDLINE
DCOM- 20100122
LR  - 20221207
IS  - 1463-1326 (Electronic)
IS  - 1462-8902 (Linking)
VI  - 11
IP  - 4
DP  - 2009 Apr
TI  - Insulin glargine provides greater improvements in glycaemic control vs. 
      intensifying lifestyle management for people with type 2 diabetes treated with 
      OADs and 7-8% A1c levels. The TULIP study.
PG  - 379-86
LID - 10.1111/j.1463-1326.2008.00980.x [doi]
AB  - AIM: To determine whether earlier administration of insulin glargine (glargine) 
      vs. the intensification of lifestyle management (LM) improves glycaemic control 
      in type 2 diabetes patients with A1c 7-8% treated with oral therapy. METHODS: 
      TULIP [Testing the Usefulness of gLargine when Initiated Promptly in type 2 
      diabetes mellitus (T2DM)] was a 9-month, 12-visit, open-label, multinational, 
      multicentre, randomized study to evaluate starting glargine or intensifying LM in 
      T2DM patients aged 40-75 years, body mass index (BMI) 24-35 kg/m2 and A1c 7-8%, 
      treated with maximum doses of metformin and sulphonylurea for > or = 2 years. 
      Glargine was injected once daily (evening) and titrated to fasting blood glucose 
      0.7-1.0 g/l. In the LM arm, dietary and physical activity counselling recommended 
      stable weight for people with BMI < 27 kg/m2 or weight loss of 3 kg for patients 
      with BMI > or = 27 kg/m2. A total of 215 patients were randomized to glargine (n 
      = 106) or LM (n = 109). The primary objective was patients achieving A1c < 7% at 
      endpoint. Secondary endpoints included changes in A1c, in fasting plasma glucose 
      (FPG), body weight and hypoglycaemia incidence. RESULTS: Two hundred and eleven 
      (52.6% male) patients were randomized and treated; mean (+/- s.d.) age 60.7 +/- 
      7.9 years, weight 84.5 +/- 13.1 kg, BMI 29.9 +/- 3.5 kg/m2 and A1c 7.6 +/- 0.4%. 
      More patients reached A1c < 7% (66 vs. 38%; p < 0.0001) or < 6.5% (34 vs. 11%; p 
      = 0.0001) with glargine vs. LM. The change in FPG from baseline to study endpoint 
      was significantly greater in the glargine vs. the LM arm (-0.50 +/- 0.47 vs. 
      -0.05 +/- 0.39 g/l respectively; p < 0.0001). Compared with the glargine group, 
      the LM group showed a decrease in weight (+0.9 +/- 2.9 vs. -2.5 +/- 3.2 kg; p < 
      0.0001), as well as the expected lower symptomatic hypoglycaemia (55.3 vs. 25.0%; 
      p < 0.0001) and nocturnal hypoglycaemia (20.4 vs. 5.6%; p = 0.0016). No 
      significant changes were observed from baseline to study endpoint in any of the 
      lipid parameters tested. CONCLUSIONS: In patients with T2DM with A1c 7-8%, who 
      were previously treated by conventional LM and OAD therapy, adding glargine 
      resulted in greater improvements in glycaemic control vs. intensifying LM.
FAU - Blickle, J-F
AU  - Blickle JF
AD  - Hopitaux Universitaires de Strasbourg, France. 
      Jean-Frederic.Blickle@chru-strasbourg.fr
FAU - Hancu, N
AU  - Hancu N
FAU - Piletic, M
AU  - Piletic M
FAU - Profozic, V
AU  - Profozic V
FAU - Shestakova, M
AU  - Shestakova M
FAU - Dain, M-P
AU  - Dain MP
FAU - Jacqueminet, S
AU  - Jacqueminet S
FAU - Grimaldi, A
AU  - Grimaldi A
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20081214
PL  - England
TA  - Diabetes Obes Metab
JT  - Diabetes, obesity & metabolism
JID - 100883645
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 0 (Insulin, Long-Acting)
RN  - 0 (hemoglobin A1c protein, human)
RN  - 2ZM8CX04RZ (Insulin Glargine)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Blood Glucose/*metabolism
MH  - Combined Modality Therapy
MH  - Diabetes Mellitus, Type 2/blood/*drug therapy/therapy
MH  - Drug Administration Schedule
MH  - Drug Therapy, Combination
MH  - Glycated Hemoglobin/metabolism
MH  - Humans
MH  - Hypoglycemia/chemically induced
MH  - Hypoglycemic Agents/administration & dosage/adverse effects/*therapeutic use
MH  - Insulin/administration & dosage/adverse effects/*analogs & 
      derivatives/therapeutic use
MH  - Insulin Glargine
MH  - Insulin, Long-Acting
MH  - *Life Style
MH  - Middle Aged
MH  - Treatment Outcome
EDAT- 2008/12/18 09:00
MHDA- 2010/01/23 06:00
CRDT- 2008/12/18 09:00
PHST- 2008/12/18 09:00 [entrez]
PHST- 2008/12/18 09:00 [pubmed]
PHST- 2010/01/23 06:00 [medline]
AID - DOM980 [pii]
AID - 10.1111/j.1463-1326.2008.00980.x [doi]
PST - ppublish
SO  - Diabetes Obes Metab. 2009 Apr;11(4):379-86. doi: 
      10.1111/j.1463-1326.2008.00980.x. Epub 2008 Dec 14.