PMID- 24918797
OWN - NLM
STAT- MEDLINE
DCOM- 20140908
LR  - 20221207
IS  - 1941-9260 (Electronic)
IS  - 0032-5481 (Linking)
VI  - 126
IP  - 3
DP  - 2014 May
TI  - Influence of baseline glycemia on outcomes with insulin glargine use in patients 
      uncontrolled on oral agents.
PG  - 111-25
LID - 10.3810/pgm.2014.05.2761 [doi]
AB  - PURPOSE: Optimizing glycemic control in patients with type 2 diabetes mellitus 
      (T2DM) not controlled with >/= 1 oral antidiabetes drugs (OADs) is challenging. 
      Many therapeutic options exist; however, data comparing the effectiveness of 
      different strategies are lacking for the management of patients with T2DM. Our 
      study aim was to provide comparative data on efficacy and hypoglycemia when 
      initiating insulin glargine (glargine) versus alternative treatment options (not 
      including the newest antidiabetes agents, glucagon-like peptide [GLP]-1 receptor 
      agonists, dipeptidyl peptidase [DPP]-4 inhibitors or sodium-glucose linked 
      transporter [SGLT]-2 inhibitors) in insulin-naive patients with T2DM who remained 
      uncontrolled with OADs. METHODS: Patient-level data were pooled from 9 randomized 
      controlled trials of >/= 24 weeks duration with comparable patient populations. The 
      effect of adding glargine was compared with intensification of lifestyle 
      interventions or OADs, addition of neutral protamine Hagedorn (NPH) insulin, 
      insulin lispro, premixed insulin, or all comparators pooled, on patient glycated 
      hemoglobin (HbA1c) level, fasting plasma glucose level, weight, and hypoglycemia. 
      RESULTS: A greater proportion of patients achieved a target HbA1c level </= 7.0% 
      with glargine treatment than with pooled comparators, intensification of OADs, or 
      lifestyle interventions; there was no difference when compared with NPH, 
      premixed, or insulin lispro use. The rate for reported hypoglycemic events was 
      lower for glargine use than for pooled comparators or other insulins, but higher 
      compared with intensification of lifestyle interventions or OADs. When stratified 
      by baseline HbA1c level, efficacy/target attainment with glargine use was better 
      than for pooled comparators across all HbA1c strata; OAD intensification, when 
      baseline HbA1c level was >/= 8.0%; and premixed insulin if baseline HbA1c level was 
      < 8.0%; but similar to other insulins for all other categories. The incidence of 
      reported hypoglycemia was less frequent with glargine use than other insulins, 
      but more frequent than intensification of lifestyle interventions or OADs. 
      CONCLUSION: When adequate glycemic control is not achieved using OADs in patients 
      with T2DM, initiating insulin glargine is generally less likely to elicit 
      hypoglycemia than initiating NPH, premixed, or prandial insulins, and the 
      benefit-risk balance supports initiating insulin rather than intensification of 
      OAD therapy when baseline HbA1c level is >/= 8.0%.
FAU - Banerji, Mary Ann
AU  - Banerji MA
AD  - Professor of Medicine and Endocrinology, Division Chief, Endocrinology at SUNY, 
      SUNY Downstate Medical Center, Brooklyn, NY. MaryAnn.Banerji@downstate.edu.
FAU - Baron, Michelle A
AU  - Baron MA
FAU - Gao, Ling
AU  - Gao L
FAU - Blonde, Lawrence
AU  - Blonde L
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Postgrad Med
JT  - Postgraduate medicine
JID - 0401147
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin, Long-Acting)
RN  - 0 (Insulins)
RN  - 0 (Sulfonylurea Compounds)
RN  - 2ZM8CX04RZ (Insulin Glargine)
SB  - IM
MH  - Administration, Oral
MH  - Blood Glucose
MH  - Body Weight
MH  - Diabetes Mellitus, Type 2/*drug therapy
MH  - Drug Therapy, Combination
MH  - Glycated Hemoglobin
MH  - Humans
MH  - Hypoglycemia/chemically induced
MH  - Hypoglycemic Agents/administration & dosage/adverse effects/*therapeutic use
MH  - Insulin Glargine
MH  - Insulin, Long-Acting/administration & dosage/adverse effects/*therapeutic use
MH  - Insulins
MH  - Randomized Controlled Trials as Topic
MH  - Sulfonylurea Compounds/therapeutic use
EDAT- 2014/06/12 06:00
MHDA- 2014/09/10 06:00
CRDT- 2014/06/12 06:00
PHST- 2014/06/12 06:00 [entrez]
PHST- 2014/06/12 06:00 [pubmed]
PHST- 2014/09/10 06:00 [medline]
AID - 10.3810/pgm.2014.05.2761 [doi]
PST - ppublish
SO  - Postgrad Med. 2014 May;126(3):111-25. doi: 10.3810/pgm.2014.05.2761.