Vol 10, No 2 (2021)
Research paper
Published online: 2021-02-22

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A prospective evaluation of the effectiveness and safety of insulin glargine 100 U/mL (Gla-100) in adults with diabetes mellitus in Poland. The LARE observational study

Grzegorz Jan Dzida1, Tomasz Szczepanik2
Clin Diabetol 2021;10(2):169-179.

Abstract

Introduction. Insulin glargine 100 U/ml (Gla-100) is  a long-lasting basal insulin analog injected once daily. This real-life study aimed to evaluate the efficacy and safety of Gla-100 in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM), who were recently switched from isophane (NPH) insulin.
Methods. This multicenter, prospective, 52-week observational study included 321 patients with T1DM and 766 with T2DM. The primary endpoint was the percentage of participants with a HbA1c reduction of ≥ 0.5% at 52 weeks. The secondary endpoints included fasting plasma glucose (FPG) and HbA1c reduction over time, and hypoglycemic events.
Results. Of the 1,087 patients included, 69.9% achieved the primary endpoint, while the mean HbA1c decreased by 1.03% and the mean FPG by 31.8 mg/dL at 52 weeks. The average annual rate of severe hypoglycemia was 0.017 events per patient-year and 0.82 events per patient-year for nocturnal hypoglycemia. The proportion of participants experiencing severe diurnal or nocturnal hypoglycemia was significantly lower in the four weeks prior to the study end than the four weeks before the switch from NPH insulin (p < 0.0001 for diurnal hypoglycemia in T1DM and < 0.002 for diurnal hypoglycemia in T2DM; p < 0.0001 for nocturnal hy-poglycemia in both T1DM and T2DM). Body weight did not change substantially throughout the study (mean increase of 0.3 kg for T1DM and 0.1 kg for T2DM). Conclusions. Patients with T1DM or T2DM in whom diabetes was not well controlled with NPH insulin treat-ment achieved better glycemic control at a lower risk of hypoglycemia after switching to Gla-100 in routine clinical practice. 

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References

  1. Hilgenfeld R, Seipke G, Berchtold H, et al. The evolution of insulin glargine and its continuing contribution to diabetes care. Drugs. 2014; 74(8): 911–927.
  2. Araszkiewicz A, Bandurska-Stankiewicz E, Budzyński A, et al. 2019 Guidelines on the management of diabetic patients. A position of Diabetes Poland. Clinical Diabetology. 2019; 8(1): 1–95.
  3. Edelman SV, Polonsky WH, Edelman SV, et al. Type 2 Diabetes in the Real World: The Elusive Nature of Glycemic Control. Diabetes Care. 2017; 40(11): 1425–1432.
  4. Kilpatrick ES, Das AK, Orskov C, et al. Good glycaemic control: an international perspective on bridging the gap between theory and practice in type 2 diabetes. Curr Med Res Opin. 2008; 24(9): 2651–2661.
  5. Vaag A, Lund SS, Lund S. Insulin initiation in patients with type 2 diabetes mellitus: treatment guidelines, clinical evidence and patterns of use of basal vs premixed insulin analogues. Eur J Endocrinol. 2012; 166(2): 159–170.
  6. Goykhman S, Drincic A, Desmangles JC, et al. Insulin Glargine: a review 8 years after its introduction. Expert Opin Pharmacother. 2009; 10(4): 705–718.
  7. Curtis B, Lage MJ. Glycemic control among patients with type 2 diabetes who initiate basal insulin: a retrospective cohort study. J Med Econ. 2014; 17(1): 21–31.
  8. Owens DR, Traylor L, Dain MP, et al. Efficacy and safety of basal insulin glargine 12 and 24 weeks after initiation in persons with type 2 diabetes: a pooled analysis of data from treatment arms of 15 treat-to-target randomised controlled trials. Diabetes Res Clin Pract. 2014; 106(2): 264–274.
  9. Rys P, Wojciechowski P, Rogoz-Sitek A, et al. Systematic review and meta-analysis of randomized clinical trials comparing efficacy and safety outcomes of insulin glargine with NPH insulin, premixed insulin preparations or with insulin detemir in type 2 diabetes mellitus. Acta Diabetol. 2015; 52(4): 649–662.
  10. Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013; 36(5): 1384–1395.
  11. Carls GS, Tuttle E, Tan RD, et al. Understanding the gap between efficacy in randomized controlled trials and effectiveness in real-world use of GLP-1 RA and DPP-4 therapies in patients with type 2 diabetes. Diabetes Care. 2017; 40(11): 1469–1478.
  12. Huang ES, Liu JY, Moffet HH, et al. Glycemic control, complications, and death in older diabetic patients: the diabetes and aging study. Diabetes Care. 2011; 34(6): 1329–1336.
  13. Miller ME, Bonds DE, Gerstein HC, et al. The effects of baseline characteristics, glycaemia treatment approach, and glycated haemoglobin concentration on the risk of severe hypoglycaemia: post hoc epidemiological analysis of the ACCORD study. BMJ. 2010; 340: b5444.
  14. Hanefeld M, Fleischmann H, Landgraf W, et al. EARLY Study: Early basal insulin therapy under real life conditions in Type 2 Diabetics. Diabetes Stoffw Herz. 2012; 21(2): 91–97.
  15. Lieverse AG, Rodrigues M, Czupryniak L, et al. Glycaemic control of type 2 diabetetics with insulin glargine in everyday practice. Diabetes Stoffw Herz. 2013; 22(3): 141–147.
  16. Pfohl M, Siegmund T, Pscherer S, et al. Effectiveness and tolerability of treatment intensification to basal-bolus therapy in patients with type 2 diabetes on previous basal insulin-supported oral therapy with insulin glargine or supplementary insulin therapy with insulin glulisine: the PARTNER observational study. Vasc Health Risk Manag. 2015; 11: 569–578.
  17. Hajos TRS, Pouwer F, de Grooth R, et al. The longitudinal association between glycaemic control and health-related quality of life following insulin therapy optimisation in type 2 diabetes patients. A prospective observational study in secondary care. Qual Life Res. 2012; 21(8): 1359–1365.
  18. Schreiber SA, Fiesselmann A, Bornstein SR, et al. Insulin analogues insulin glargine and insulin glulisine in type 1 diabetes. Diabetes Stoffw Herz. 2011; 20: 69–77.
  19. Seufert J, Fritsche A, Pscherer S, et al. Titration and optimization trial for the initiation of insulin glargine 100 U/mL in patients with inadequately controlled type 2 diabetes on oral antidiabetic drugs. Diabetes Obes Metab. 2019; 21(2): 439–443.
  20. Zoungas S, Patel A, Chalmers J, et al. Severe hypoglycemia and risks of vascular events and death. N Engl J Med. 2010; 363(15): 1410–1418.
  21. Heinemann L, Linkeschova R, Rave K, et al. Time-action profile of the long-acting insulin analog insulin glargine (HOE901) in comparison with those of NPH insulin and placebo. Diabetes Care. 2000; 23(5): 644–649.
  22. Horvath K, Jeitler K, Berghold A, et al. Long-acting insulin analogues versus NPH insulin (human isophane insulin) for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2007(2): CD005613.
  23. van Avendonk MJP, Rutten GE. Insulin therapy in type 2 diabetes: what is the evidence? Diabetes Obes Metab. 2009; 11(5): 415–432.
  24. Garber AJ. Treat-to-target trials: uses, interpretation and review of concepts. Diabetes Obes Metab. 2014; 16(3): 193–205.
  25. Monami M, Marchionni N, Mannucci E. Long-acting insulin analogues versus NPH human insulin in type 2 diabetes: a meta-analysis. Diabetes Res Clin Pract. 2008; 81(2): 184–189.
  26. Ji L, Zhang P, Zhu D, et al. ORBIT study group. Comparative effectiveness and safety of different basal insulins in a real-world setting. Diabetes Obes Metab. 2017; 19(8): 1116–1126.
  27. Davies M, Sinnassamy P, Storms F, et al. Insulin glargine-based therapy improves glycemic control in patients with type 2 diabetes sub-optimally controlled on premixed insulin therapies. Diabetes Res Clin Pract. 2008; 79(2): 368–375.
  28. Cigrovski Berkovic M, Petrovski G, Grulovic N. Effectiveness of insulin glargine in type 2 diabetes mellitus patients failing glycaemic control with premixed insulin: Adriatic countries data meta-analysis. Acta Diabetol. 2016; 53(5): 709–715.
  29. Erpeldinger S, Rehman MB, Berkhout C, et al. Efficacy and safety of insulin in type 2 diabetes: meta-analysis of randomised controlled trials. BMC Endocr Disord. 2016; 16(1): 39.
  30. Holman RR, Farmer AJ, Davies MJ, et al. 4-T Study Group. Three-year efficacy of complex insulin regimens in type 2 diabetes. N Engl J Med. 2009; 361(18): 1736–1747.
  31. Riebenfeld D, Spirk D, Mathis A, et al. Treatment intensification with insulin glargine in patients with inadequately controlled type 2 diabetes improves glycaemic control with a high treatment satisfaction and no weight gain. Swiss Med Wkly. 2015; 145: w14114.
  32. Zhang Y, Xie YJ, Meng DD, et al. Clinical study of treatment switching from premixed insulin to basal insulin combined with oral hypoglycemic drugs in patients with type 2 diabetes. Diabetol Metab Syndr. 2014; 6(1): 37.
  33. Eliaschewitz FG, Calvo C, Valbuena H, et al. Therapy in type 2 diabetes: insulin glargine vs. NPH insulin both in combination with glimepiride. Arch Med Res. 2006; 37(4): 495–501.
  34. Ligthelm RJ, Borzì V, Gumprecht J, et al. Importance of observational studies in clinical practice. Clin Ther. 2007; 29(6 Pt 1): 1284–1292.
  35. Nathan DM, Buse JB, Kahn SE, et al. Rationale and design of the glycemia reduction approaches in diabetes: a comparative effectiveness study (GRADE). Diabetes Care. 2013; 36(8): 2254–2261.
  36. A Comparative Effectiveness Study of Major Glycemia-lowering Medications for Treatment of Type 2 Diabetes (GRADE). Available from: https://clinicaltrials.gov/ct2/show/NCT01794143. Accessed 17/01/2020.