en
Scientific article
English

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

ContributorsDavies, Melanie; Lavalle-González, F.; Storms, F.; Gomis, R.; AT.LANTUS Study Group
Published inDiabetes, obesity & metabolism, vol. 10, no. 5, p. 387-399
Publication date2008
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, 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
Citation (ISO format)
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 & metabolism, 2008, vol. 10, n° 5, p. 387–399. doi: 10.1111/j.1463-1326.2008.00873.x
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Article (Accepted version)
accessLevelRestricted
Identifiers
ISSN of the journal1462-8902
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