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Once-Daily Basal Insulin as Effective as Prandial

Once-daily treatment with insulin glargine lowers hemoglobin A1c as effectively as prandial lispro, according to an open-label study published in Lancet and performed by glargine's maker.

Some 400 adults whose type 2 diabetes was inadequately controlled with oral medications were randomized to take insulin glargine once daily or insulin lispro three times daily before meals. After 44 weeks, HbA1C was reduced as effectively with glargine as with lispro (mean reduction, –1.7 and –1.9 percentage points, respectively). Glargine recipients were less likely to experience hypoglycemia (66% vs. 89%), and they expressed more treatment satisfaction.

The authors call the addition of glargine to oral hypoglycemic agents a "simple and well tolerated intervention ... that can be regarded as a first-line insulin initiation approach in type 2 diabetes mellitus, as has been recommended in a joint consensus guideline" by American and European diabetes associations.

LINK(S):

Lancet article (Free abstract with one-time registration; full text requires subscription)

Lancet comment (Subscription required)

Consensus statement on type 2 diabetes management from the American Diabetes Association and the European Association for the Study of Diabetes (Free)

Published in Physician's First Watch March 28, 2008