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Title

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

Authors
Davies, Melanie
Lavalle-González, F.
Storms, F.
Gomis, R.
CollaborationWith : Philippe, Jacques / Schoenenweid, Claude Leon Marie
Published in Diabetes, Obesity and Metabolism. 2008, vol. 10, no. 5, p. 387-99
Abstract 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.
Keywords Administration, OralAdultAgedAlgorithmsBlood Glucose/metabolismBody WeightCircadian RhythmDiabetes Mellitus, Type 2/blood/drug therapyDrug Administration ScheduleDrug Therapy, CombinationFemaleHemoglobin A, Glycosylated/metabolismHumansHypoglycemia/chemically inducedHypoglycemic Agents/adverse effects/therapeutic useInsulin/adverse effects/analogs & derivatives/therapeutic useMaleMiddle AgedProspective Studies
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PMID: 18355327
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DAVIES, Melanie et al. Initiation of insulin glargine therapy in type 2 diabetes subjects suboptimally controlled on oral antidiabetic agents: results from the AT.LANTUS trial. In: Diabetes, Obesity and Metabolism, 2008, vol. 10, n° 5, p. 387-99. https://archive-ouverte.unige.ch/unige:3665

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Deposited on : 2009-10-05

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