Initiation of insulin glargine therapy in type 2 diabetes subjects suboptimally controlled on oral antidiabetic agents: results from the AT.LANTUS trial

• Published in: Diabetes, obesity & metabolism Vol. 10; no. 5; pp. 387 - 399
• Main Authors: Davies, M, Lavalle-González, F, Storms, F, Gomis, R
• Format: Journal Article
• Language: English
• Published: Oxford, UK Oxford, UK : Blackwell Publishing Ltd 01.05.2008; Blackwell Publishing Ltd
• Subjects: Administration, Oral; Adult; adverse effects; Aged; Algorithms; analogs & derivatives; basal insulin analogues; blood; Blood Glucose; Blood Glucose - metabolism; Body Weight; chemically induced; Circadian Rhythm; Diabetes Mellitus, Type 2; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Drug Administration Schedule; drug therapy; Drug Therapy, Combination; Female; Glycated Hemoglobin; Glycated Hemoglobin A - metabolism; Humans; Hypoglycemia; Hypoglycemia - chemically induced; Hypoglycemic Agents; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Insulin; Insulin - adverse effects; Insulin - analogs & derivatives; Insulin - therapeutic use; Insulin Glargine; Insulin, Long-Acting; Male; metabolism; Middle Aged; noninsulin-dependent diabetes mellitus; oral antidiabetic agents; Prospective Studies; therapeutic use; titration; treatment algorithms; type 2 diabetes
• ISSN: 1462-8902; 1463-1326; 1463-1326
• DOI: 10.1111/j.1463-1326.2008.00873.x

For many patients with type 2 diabetes, oral antidiabetic agents (OADs) do not provide optimal glycaemic control, necessitating insulin therapy. Fear of hypoglycaemia is a major barrier to initiating insulin therapy. The AT.LANTUS study investigated optimal methods to initiate and maintain insulin glargine (LANTUS®, glargine, Sanofi-aventis, Paris, France) therapy using two treatment algorithms. This subgroup analysis investigated the initiation of once-daily glargine therapy in patients suboptimally controlled on multiple OADs. This study was a 24-week, multinational (59 countries), multicenter (611), randomized study. Algorithm 1 was a clinic-driven titration and algorithm 2 was a patient-driven titration. Titration was based on target fasting blood glucose Of the 4961 patients enrolled in the study, 865 were included in this subgroup analysis: 340 received glargine plus 1 OAD and 525 received glargine plus >1 OAD. Incidence of severe hypoglycaemia was <1%. HbA₁c decreased significantly between baseline and end-point for patients receiving glargine plus 1 OAD (-1.4%, p < 0.001; algorithm 1 -1.3% vs. algorithm 2 -1.5%; p = 0.03) and glargine plus >1 OAD (-1.7%, p < 0.001; algorithm 1 -1.5% vs. algorithm 2 -1.8%; p = 0.001). This study shows that initiation of once-daily glargine with OADs results in significant reduction of HbA₁c with a low risk of hypoglycaemia. The greater reduction in HbA₁c was seen in patients randomized to the patient-driven algorithm (algorithm 2) on 1 or >1 OAD.