18. Why Basal insulin Early?
Treating fasting hyperglycemia lowers
the entire 24-hour plasma glucose profile
400
Plasma glucose (mmol/l)
20
T2DM
Plasma glucose (mg/dl)
300
15
200 Hyperglycaemia due to an increase in fasting glucose
10
100
5
Normal
Meal Meal Meal
0 0
06.00 10.00 14.00 18.00 22.00 02.00 06.00
Comparison of 24-hour glucose levels in control subjects vs patients with diabetes (p<0.001).
Adapted from Hirsch I, et al. Clin Diabetes 2005;23:78–86. Time of day (hours)
19.
20.
21.
22.
23.
24.
25.
26. Reduced risk of nocturnal
hypoglycaemia with insulin glargine
42%
NPH
8 risk reduction
6.9 44% Insulin glargine
Events per patient–year
7
risk reduction
6 5.5
p<0.001
5
p<0.001
4.0 48%
4
3.1 risk reduction
3 2.5
p<0.002
2
1.3
1
0
* **
All nocturnal Confirmed nocturnal
hypoglycaemia hypoglycaemia
Confirmed hypoglycaemia: *4 mmol/l (72 mg/dl); **3.1 mmol/l (56 mg/dl)
Riddle M. et al. Diabetes Care 2003;26:3080–6.
27. Insulin glargine reduces hypoglycemic
risk versus NPH in T2DM: Meta analysis
Risk of severe hypoglycaemia and severe nocturnal hypoglycemia reduced
by 46% (p = 0.04) and 59% (p = 0.02), respectively, with insulin glargine
Risk reduction mainly
observed at night
Symptomatic hypoglycaemic events
Mean (CI)
Overall 0.711 (0.586, 0.862); p = 0.001
Nocturnal 0.591 (0.486, 0.718); p < 0.001
Daytime 0.931 (0.771, 1.123); p = 0.455
0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 2.0
Reduced risk Increased risk
Odds ratio
Rosenstock J, et al. Diabetes Care 2005;28:950−5.
28. LANTUS-BOT: after 5 years on Insulin Glargine,
83% of patients still did not require intensification
Retrospective cohort analysis from a German database comparing
the persistence of T2DM patients on basal insulin plus OADs with i
patients treated with NPH plus OADs
28
Pfohl M, et al. Adding insulin glargine to oral therapy in type 2 diabetes patients results in longer persistence with the treatment
regimen compared to NPH insulin. Poster presented at ISPOR 2008
29. Schreiber et al: following titration, Insulin Glargine + oral
antidiabetic drugs can provide sustained glycaemic
control
Observational study initiated in 12,216 insulin-naïve subjects with T2DM,
who added Insulin Glargine to their existing OAD treatment i
The study duration was 9 months, followed by optional 20- and 32-month extension
phases
29
Schreiber SA et al. Diabetes Obes Metab 2007;9(1):31–38; Schreiber SA, et al. Diabetes Technol Ther 2008;10(2):121–127
30. NEW THIN: switching from NPH to Insulin Glargine
improves HbA1c control in real life
Retrospective analysis from a UK database analysing the switch
from NPH to Insulin Glargine in patients with TD2M i
30
Gordon J, et al. ADA 2009, abstract accepted
42. Advice For Physicians
Don't wait forever. "Patient needs insulin
therapy,"
Don't be afraid of hypoglycaemia, but be
aware of it.
Consider combination therapy ( insulin +
OAD ).
Don't under-insulinize.