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More Patients Reach Target HbA1c with an Approach Combining Insulin Glargine and Glulisine

Value-Based Care in Cardiometabolic Health August 2012, Vol 1, No 2

Of 713 patients in a pooled analysis, approximately 45% were at target hemoglobin (Hb) A1c  levels (ie, <7%) after 6 months of basal-plus treatment compared with 20% at baseline when taking oral anti­diabetic drugs and insulin glargine (P <.001). Stefano Del Prato, MD, Professor of Endocrinology and Metabolism (School of Medicine) and Chief of the Section of Diabetes, University of Pisa, Italy, presented the data at the 2012 ADA annual meeting.

The patients had poorly controlled type 2 diabetes (HbA1c >7%) when taking oral antidiabetic drugs and insulin glargine. The mean baseline HbA1c was 7.6%, and the overall prevalence of severe hypoglycemia was 1.7%.

For the basal-plus regimen, insulin glulisine once daily at mealtime was added to insulin glargine for up to 6 months. The investigators pooled data from 4 previously reported clinical trials using this basal-plus regimen.

Dr Del Prato said the basal-plus regimen is becoming an increasingly common step when it is necessary to intensify insulin therapy, and that a single mealtime injection of a rapid-acting insulin analog, such as insulin glulisine, is added to antidiabetic drugs and once-daily basal insulin. This is thought to more closely mimic physiologic insulin levels and achieve good glycemic control with fewer daily injections.

Treatment guidelines recommend adding a prandial insulin, when needed, to reduce peaks of postprandial glucose (PPG).

In this analysis, the basal-plus regimen was associated with significant reductions in HbA1c and PPG (P <.001). Over 6 months, mean HbA1c levels were reduced by nearly 0.5% (from 7.6% at baseline to 7.1%), and mean PPG levels were reduced by almost 55 mg/dL.

Although the doses of insulin glargine and glulisine increased significantly from baseline, no significant increases in body weight or body mass index were observed.

The insulin glargine dose increased from 36.8 to 41.9 U daily, and the insulin glulisine dose increased from 4.9 to 13.2 U daily.

These results suggest that patients with type 2 diabetes who were previously uncontrolled with an antidiabetic drug and insulin glargine would have improved glycemic control by the addition of once-daily insulin glulisine, said Dr Del Prato.

Last modified: August 30, 2021