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Original article

Vol. 145 No. 0910 (2015)

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

  • Daniela Riebenfeld
  • David Spirk
  • Alexandra Mathis
  • Lukas Villiger
  • Philipp Gerber
  • Urs Erwin Gasser
  • Roger Lehmann
DOI
https://doi.org/10.4414/smw.2015.14114
Cite this as:
Swiss Med Wkly. 2015;145:w14114
Published
22.02.2015

Abstract

PRINCIPLES: We aimed to evaluate the efficacy of, and treatment satisfaction with, insulin glargine administered with SoloSTAR® or ClikSTAR® pens in patients with type 2 diabetes mellitus managed by primary care physicians in Switzerland.

METHODS: A total of 327 patients with inadequately controlled type 2 diabetes were enrolled by 72 physicians in this prospective observational study, which aimed to evaluate the efficacy of a 6-month course of insulin glargine therapy measured as development of glycaemic control (glycosylated haemoglobin [HbA1c] and fasting plasma glucose [FPG]) and weight change. We also assessed preference for reusable or disposable pens, and treatment satisfaction.

RESULTS: After 6 months, the mean daily dose of insulin glargine was 27.7 ± 14.3 U, and dose titration was completed in 228 (72.4%) patients. Mean HbA1c decreased from 8.9% ± 1.6% (n = 327) to 7.3% ± 1.0% (n = 315) (p <0.0001), and 138 (43.8%) patients achieved an HbA1c ≤7.0%. Mean FPG decreased from 10.9 ± 4.5 to 7.3 ± 1.8 mmol/l (p <0.0001). Mean body weight did not change (85.4 ± 17.2 kg vs 85.0 ± 16.5 kg; p = 0.11). Patients’ preference was in favour of the disposable SoloStar® pen (80%), as compared with the reusable ClickStar® pen (20%). Overall, 92.6% of physicians and 96.3% of patients were satisfied or very satisfied with the insulin glargine therapy.

CONCLUSIONS: In patients with type 2 diabetes insulin glargine administered by SoloSTAR® or ClikSTAR® pens, education on insulin injection and on self-management of diabetes was associated with clinically meaningful improvements in HbA1c and FPG without a mean collective weight gain. The vast majority of both patients and primary care physicians were satisfied with the treatment intensification.

References

  1. Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus, present and future perspectives. Nat Rev Endocrinol. 2011;8(4):228–36.
  2. Kaiser A, Vollenweider P, Waeber G, Marques-Vidal P. Prevalence, awarness and treatment of type 2 diabetes mellitus in Switzerland: the CoLaus study. Diabet Med. 202;29:190–7.
  3. Stratton IM, Adler AI, Neil HAW, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macro- vascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321:405–12.
  4. Saydah S, Tao M, Imperatore G, Gregg E. GHb level and subsequent mortality among adults in the U.S. Diabetes Care. 2009;32:1440–6.
  5. Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375:2215–22.
  6. Gerstein HC, Islam S, Anand S, Almahmeed W, Damasceno A, Dans A, et al. Dysglycaemia and the risk of acute myocardial infarction in multiple ethnic groups: an analysis of 15,780 patients from the INTERHEART study. Diabetologia. 2010;53:2509–17.
  7. Blonde L. State of diabetes health. 2006 Available from http://www.stateofdiabetes.com/state_compare.htm.
  8. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al.; American Diabetes Association (ADA); European Association for the Study of Diabetes (EASD). Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35(6):1364–79 / Diabetologia. 2012;55(6):1577–96.
  9. Aschner P, Chan J, Owens DR, Picard S, Wang E, Dain M-P, et al., on behalf of the EASIE investigators. Insulin glargine versus sitagliptin in insulin-naive patients with type 2 diabetes mellitus uncontrolled on metformin (EASIE): a multicentre, randomised open-label trial. Lancet. 2012;379:2262–6229.
  10. Riddle C (on behalf of the ORIGIN trial investigators). Characteristics Associated With Maintenance of Mean A1C <6.5% in People with Dysglycemia in the ORIGIN Trial. Diabetes Care. 2013;36(10):2915–22.
  11. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et al. Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. American Diabetes Association, European Association for the Study of Diabetes. Diabetologia. 2009;52(1):17–30.
  12. Philippe J, Brändle M, Carrel J, Diem P, Keller U, Kuntschen F, et al. Massnahmen zur Blutzuckerkontrolle bei Patienten mit Typ-2–Diabetes-Mellitus: Consensus Statement der Schweizerischen Gesellschaft für Endokrinologie und Diabetes (SGED): Schweiz Med Forum. 2009;9(3):50–5. German.
  13. Lehmann R, Henzen Ch, Christ E. Neue Richtlinien der SGED/SSED zur Therapie des Typ 2 Diabetes mellitus. info@herz+gefäss 2013;4:20–4. German.
  14. Wang F, Vergara CM. Insulin glargine: a systematic review of a long-acting insulin analogue. Clin Ther. 2003;25:1541–77.
  15. Riddle MC, Rosenstock J, Gerich J. The Treat-to-Target Trial: Randomised addition of Glargine or human NHP insulin to oral therapy of type 2 diabetic patients Diabetes Care. 2003;26(11):3080–6.
  16. Yki-Jarvinen H, Yki-Järvinen H, Juurinen Ll, Alvarsson M, Bystedt T, Davies M, et al. Initiate Insulin by Aggressive Titration and Education (Initiate a Randomized Study to Compare Initiation of Insulin Combination Therapy in Type 2 Diabetic Patients Individually And in Groups. Diabetes Care. 2007;30:1364–70.
  17. Bretzel RG, Nuber U, Landgraf W, Owens DR, Bradley C, Linn Th. Once-daily basal insulin glargine versus thrice-daily prandial insulin lispro in people with type 2 diabetes on oral hypoglycaemic agents (APOLLO): an open randomised controlled trial. Lancet. 2008;371:1073–84.
  18. Fritsche A. Langwirkende Analoginsuline: Ergebnisse mit Insulin glargine: Dtsch Med Wochenschr. 2008;133:S101–S105. German.
  19. Davies M, Lavalle-Gonzalez F, Storms F, Gomis R. (on behalf of the AT.LANTUS Study Group). Initiation of insulin glargine therapy in type 2 diabetes subjects suboptimally controlled on oral anti-diabetic agents: results from the AT.LANTUS trial. Diabetes, Obesity and Metabolism. 2008;10:387–99.
  20. Rosenstock M, Davies P, Home D, Larsen J, Koenen C, Schernthaner G. A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 Diabetes. Diabetologia. 2008;51:408–16.
  21. Fonseca V, J. Gill J, Zhou R, Leahy J. An analysis of early insulin glargine added to metformin with or without sulfonylurea: impact on glycaemic control and hypoglycaemia. Diabetes Obes Metab. 2011;13:814–22.
  22. Spirk D, Lareida J, Scheidegger K, Diem P. Optimierung der glykämischen Kontrolle und Dosistitration mit Insulin Glargine (Lantus®) durch frei praktizierende Ärzte in der Schweiz: Resultate des OPTI-LAN Praxiserfahrungsberichtes. Praxis. 2009;98:315–20. German.
  23. Gerber P, Spirk D, Braendle M, Thoenes M, Lehmann R, Keller U. Regional differences of glycaemic control in patients with type 2 diabetes mellitus in Switzerland. Swiss Med Wkly. 2011, doi:10.4414/smw.2011.13218
  24. Home PD, Fritsche A, Schinzel S, Massi-Benedetti M. Meta-analysis of individual patient data to assess the risk of hypoglycaemia in people with type 2 diabetes using NPH insulin or insulin glargine. Diabetes Obes Metab. 2010;12:772–9.
  25. Polonsky W, Traylor L, Wei W, Shi R, Ameer B, Vlajnic A, et al. More satisfied, but why? A pooled patient-level analysis of treatment satisfaction following the initiation of insulin glargine versus comparators in insulin-naïve patients with type 2 diabetes mellitus. Diabetes Obes Metab. 2013; doi: 10.1111/dom.12214.
  26. Hancu N, Czupryniak L, Genestin E, Sourij H. A Pan-European and Canadian prospective survey to evaluate patient satisfaction with the SoloSTAR insulin injection device in type 1 and type 2 diabetes. J Diabetes Sci Technol. 2011;5:1224–34. German.
  27. Böhler S, Landgraf W, Schreiber SA. Bewertung des neuen Insulin- Fertigpens und Injektionsgewohnheiten von Diabetikern in der täglichen Praxis. MMW-Fortschritte der Medizin Originalen 2009;IV:179–87. German.
  28. Lagger G, Zoltan P, Golay A. Efficacy of therapeutic patient education in chronic disease and obesity. Patient Educ Couns. 2010;79:283–6.
  29. Golay A, Lagger G, Chambouleyron, Carrard I, Lasserre-Moutet A. Therapeutic education of diabetic patients. Diabetes Metab Res Rev. 2008;24:192–6.
  30. http://www.swissmedicinfo.ch. Fachinformation für Lantus®ClikSTAR und Lantus® SoloSTAR®. Sanofi-Aventis (Schweiz) AG. German.
  31. American Diabetes Association. Standards of medical care in diabetes – 2012. Diabetes Care. 2012;35(Suppl 1):S11–63.
  32. Effects of Intensive Glucose Lowering in Type 2 Diabetes The Action to Control Cardiovascular Risk in Diabetes Study Group. N Engl J Med. 2008;358:2545–59.
  33. Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 Diabetes. The ADVANCE Collaborative Group. N Engl J Med. 2008;358:2560–72.
  34. Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al.; VADT Investigators. N Engl J Med. 2009;360(2):129–39.

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