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

Article Article scientifique Article Initiation of insulin glargine therapy in type 2 diabetes subjects suboptimally controlled on oral antidiabetic agents: results from the AT.LANTUS trial eng 2008 author Davies Melanie author Lavalle-González F. author Storms F. author Gomis R. collaborator Philippe Jacques 26481 collaborator Schoenenweid Claude Leon Marie 21963 AT.LANTUS Study Group 387-399 10.1111/j.1463-1326.2008.00873.x 18355327 1462-8902 OBJECTIVE: 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. RESEARCH DESIGN AND METHODS: 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 < or =100 mg/dl (< or =5.5 mmol/l). Algorithms were compared for incidence of severe hypoglycaemia [requiring assistance and blood glucose <50 mg/dl (<2.8 mmol/l)] and baseline to end-point change in haemoglobin A(1c) (HbA(1c)). RESULTS: 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%. HbA(1c) 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). CONCLUSIONS: This study shows that initiation of once-daily glargine with OADs results in significant reduction of HbA(1c) with a low risk of hypoglycaemia. The greater reduction in HbA(1c) was seen in patients randomized to the patient-driven algorithm (algorithm 2) on 1 or >1 OAD. Administration, Oral Adult Aged Algorithms Blood Glucose/metabolism Body Weight Circadian Rhythm Diabetes Mellitus, Type 2/blood/drug therapy Drug Administration Schedule Drug Therapy, Combination Female Hemoglobin A, Glycosylated/metabolism Humans Hypoglycemia/chemically induced Hypoglycemic Agents/adverse effects/therapeutic use Insulin/adverse effects/analogs & derivatives/therapeutic use Male Middle Aged Prospective Studies Dewey 616 56 Département de médecine 221 false Diabetes, obesity & metabolism 10 5 feda06ca-6eeb-45ef-99d3-33eb1e5106f4 Article (Accepted version) Restricted Article.pdf 227372 application/pdf restrictedAccess Faculté de médecine / Section de médecine clinique / Département de médecine

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Initiation of insulin glargine therapy in type 2 diabetes subjects suboptimally controlled on oral antidiabetic agents: results from the AT.LANTUS trial	Diabetes, obesity & metabolism			2008	890	8

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Schoenenweid, Claude Leon Marie