The effect of low dose glargine U 300 on uncontrolled type 2 diabetes mellitus. An observational study in Indian patients

Abstract

Introduction. Insulin therapy plays an important role in the management of diabetes mellitus. The primary goal of insulin therapy is to achieve the best possible glycemic control without hypoglycemia. First-generation basal insulin (BI) analogues, such as insulin glargine 100 U/mL (Gla-100) and insulin detemir (IDet), provide more prolonged and stable activity than neutral protamine Hagedorn (NPH) insulin, with a lower risk of hypoglycemia. Insulin glargine 300 U/mL (glargine U 300) is a long acting basal insulin analogue approved for the treatment of diabetes mellitus. Insulin glargine 300 U/mL has a more stable and prolonged pharmacokinetic/pharmacodynamics profile than insulin glargine 100 U/mL, with a duration of glucose-lowering activity exceeding 24 h. Although the average daily insulin dose was higher, hypoglycemia episodes were lower in patients treated with Gla-300 compared with those treated with Gla-100. This is due to a more extended time action profile than Gla-100 resulting in a more stable and sustained glycemic control. The formulation of Gla-100 delivers the same amount of Insulin as Gla-300, in a third of the injection volume. It is essential to determine whether the clinical benefits of hypoglycemia reduction observed with insulin glargine in RCTs translate into a real-life clinical practice setting.

Materials and methods. Fifty patients diagnosed with type 2 diabetes mellitus with uncontrolled plasma glucose levels (HbA1c of > 7.5) who were on oral hypoglycemic agents, premix insulin and basal bolus therapy were enrolled into the study and started on glargine U 300 at a dose of 0.2 IU/kg and analysed for glycemic and kidney function parameters. The patients were followed up at 3 and 6 months post treatment.

Results. All glycemic control parameters decreased significantly with almost a 50% decline in both FBS and PBS from baseline to 6 months. The HbA1c decreased significantly from baseline to 3 months and 6 months post treatment by 18% and 29% respectively. All biochemical parameters were found to be statistically significant in both groups.

Conclusions. In patients with uncontrolled type 2 diabetes, switching from either OHAs or insulin to Gla-300 improves glycemic control, with a low incidence of hypoglycemia. These results confirm the effectiveness and safety of Gla-300 in a real-world setting and show that Gla-300 is a suitable therapy option for patients with diabetes.