PMID- 26566714
OWN - NLM
STAT- MEDLINE
DCOM- 20170118
LR  - 20221207
IS  - 1742-1241 (Electronic)
IS  - 1368-5031 (Print)
IS  - 1368-5031 (Linking)
VI  - 70
IP  - 1
DP  - 2016 Jan
TI  - How much is too much? Outcomes in patients using high-dose insulin glargine.
PG  - 56-65
LID - 10.1111/ijcp.12747 [doi]
AB  - BACKGROUND AND OBJECTIVES: Many patients with type 2 diabetes mellitus (T2DM) do 
      not achieve glycaemic control targets on basal insulin regimens. This analysis 
      investigated characteristics, clinical outcomes and impact of concomitant oral 
      antidiabetes drugs (OADs) in patients with T2DM treated with high-dose insulin 
      glargine. METHODS: Patient-level data were pooled from 15 randomised, 
      treat-to-target trials in patients with T2DM treated with insulin glargine +/- OADs 
      for >/= 24 weeks. Data were stratified according to whether patients exceeded three 
      insulin dose cut-off levels (> 0.5, > 0.7 and > 1.0 IU/kg). End-points included 
      glycated haemoglobin A1c (A1C), fasting plasma glucose, body weight, and overall, 
      nocturnal and severe hypoglycaemia. RESULTS: Data from 2837 insulin-naive 
      patients were analysed. Patients with insulin titrated beyond the three doses 
      investigated had significantly higher baseline A1C levels and were younger, with 
      shorter diabetes duration than those at/below cut-offs (p < 0.05 for all 
      cut-offs); they also had greater weight gain (p < 0.001 for the > 0.5 and > 0.7 
      IU/kg cut-offs) than those who did not exceed the cut-offs, regardless of 
      concomitant OAD. Patients on concomitant metformin alone had higher insulin doses 
      at Week 24, but achieved greater reductions in A1C, less weight gain and lower 
      hypoglycaemia rates than patients on a concomitant sulfonylurea or metformin plus 
      a sulfonylurea, regardless of whether cut-offs were exceeded. CONCLUSION: In 
      patients with T2DM, increasing basal insulin doses above 0.5 IU/kg may not 
      improve glycaemic control; treatment strategies targeting postprandial glucose 
      control should be considered for such patients.
CI  - (c) 2015 Authors. International Journal of Clinical Practice Published by John 
      Wiley & Sons Ltd.
FAU - Reid, T
AU  - Reid T
AD  - Mercy Diabetes Center, Janesville, WI, USA.
FAU - Gao, L
AU  - Gao L
AD  - Analysta Inc., Somerset, NJ, USA.
FAU - Gill, J
AU  - Gill J
AD  - Sanofi US, Inc., Bridgewater, NJ, USA.
FAU - Stuhr, A
AU  - Stuhr A
AD  - Sanofi US, Inc., Bridgewater, NJ, USA.
FAU - Traylor, L
AU  - Traylor L
AD  - Sanofi US, Inc., Bridgewater, NJ, USA.
FAU - Vlajnic, A
AU  - Vlajnic A
AD  - Sanofi US, Inc., Bridgewater, NJ, USA.
FAU - Rhinehart, A
AU  - Rhinehart A
AD  - Johnstone Memorial Diabetes Care Center, Abingdon, VA, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20151113
PL  - India
TA  - Int J Clin Pract
JT  - International journal of clinical practice
JID - 9712381
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Sulfonylurea Compounds)
RN  - 0 (hemoglobin A1c protein, human)
RN  - 2ZM8CX04RZ (Insulin Glargine)
RN  - 9100L32L2N (Metformin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Diabetes Mellitus, Type 2/blood/*drug therapy
MH  - Drug Therapy, Combination/adverse effects
MH  - Female
MH  - Glycated Hemoglobin/metabolism
MH  - Humans
MH  - Hypoglycemia/chemically induced
MH  - Hypoglycemic Agents/*administration & dosage/adverse effects
MH  - Insulin Glargine/*administration & dosage/adverse effects
MH  - Male
MH  - Metformin/therapeutic use
MH  - Middle Aged
MH  - Sulfonylurea Compounds/therapeutic use
MH  - Weight Gain/drug effects
PMC - PMC4738456
EDAT- 2015/11/15 06:00
MHDA- 2017/01/19 06:00
PMCR- 2016/02/03
CRDT- 2015/11/15 06:00
PHST- 2015/11/15 06:00 [entrez]
PHST- 2015/11/15 06:00 [pubmed]
PHST- 2017/01/19 06:00 [medline]
PHST- 2016/02/03 00:00 [pmc-release]
AID - IJCP12747 [pii]
AID - 10.1111/ijcp.12747 [doi]
PST - ppublish
SO  - Int J Clin Pract. 2016 Jan;70(1):56-65. doi: 10.1111/ijcp.12747. Epub 2015 Nov 
      13.