Improvement of glycemic control in subjects with poorly controlled type 2 diabetes: comparison of two treatment algorithms using insulin glargine.
Objective: Large prospective studies have demonstrated that optimum glycemic control is not routinely achieved in clinical practice. Barriers to optimal insulin therapy include hypoglycemia, weight gain, and suboptimal initiation and dose titration. This study compared two treatment algorithms for i...
| Publicado en: | Diabetes Care Vol. 28; no. 6; pp. 1282 - 1289 |
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| Autores principales: | , , , , , , , , , |
| Formato: | clinical trial research tables/charts Journal Article |
| Publicado: |
American Diabetes Association
Jun2005
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106380810&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106380810 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01495992 1G7 jtl: Diabetes Care issn: 01495992 maglogo: N pubinfo: dt: Jun2005 vid: 28 iid: 6 pid: 1367 pub: American Diabetes Association place: Arlington, Virginia artinfo: ui: 106380810 106380810 NLM15920040 2009077406 10.2337/diacare.28.6.1282 NLM15920040 106380810 ppf: 1282 ppct: 7 formats: tig: atl: Improvement of glycemic control in subjects with poorly controlled type 2 diabetes: comparison of two treatment algorithms using insulin glargine. aug: au: Davies M Storms F Shutler S Bianchi-Biscay M Gomis R Davies, Melanie Storms, Fred Shutler, Simon Bianchi-Biscay, Monique Gomis, Ramon affil: University Hospitals of Leicester, Leicester Royal Infirmary, Infirmary Close, Leicester LE1 5WW, U.K sug: subj: Diabetes Mellitus, Type 2 Drug Therapy Insulin Administration and Dosage Blood Glucose Metabolism Glycemic Control Insulin Analogs and Derivatives Insulin Therapeutic Use Blood Glucose Drug Effects Glycated Hemoglobin Analysis Treatment Outcomes Hypoglycemia Clinical Trials Confidence Intervals Analysis of Covariance Middle Age Aged Female Male Funding Source Human Middle Aged: 45-64 years Aged: 65+ years Female Male ab: Objective: Large prospective studies have demonstrated that optimum glycemic control is not routinely achieved in clinical practice. Barriers to optimal insulin therapy include hypoglycemia, weight gain, and suboptimal initiation and dose titration. This study compared two treatment algorithms for insulin glargine initiation and titration: algorithm 1 (investigator led) versus algorithm 2 (performed by study subjects).Research Design and Methods: A prospective, multicenter (n = 611), multinational (n = 59), open-label, 24-week randomized trial in 4,961 (algorithm 1, n = 2,493; algorithm 2, n = 2,468) suboptimally controlled type 2 diabetic subjects.Results: At baseline, mean diabetes duration was 12.3 +/- 7.2 years, and 72% of subjects were pretreated with insulin. At end point, there was no significant difference in the incidence of severe hypoglycemia between algorithms 1 and 2 (0.9 vs. 1.1%). There was a significant reduction in HbA(1c) from 8.9 +/- 1.3 to 7.8 +/- 1.2%, with a greater decrease (P < 0.001) with algorithm 2 (-1.22%) versus algorithm 1 (-1.08%). Fasting blood glucose decreased from 170 to 110 mg/dl, with a greater decrease (P < 0.001) with algorithm 2 (-62 mg/dl) versus algorithm 1 (-57 mg/dl). Mean basal insulin dose increased from 22.9 +/- 15.5 to 43.0 +/- 25.5 IU, with a significant difference (P < 0.003) between algorithm 2 (21.6 IU) and algorithm 1 (18.7 IU).Conclusions: Glargine is safe and effective in improving glycemic control in a large, diverse population with longstanding type 2 diabetes. A simple subject-administered titration algorithm conferred significantly improved glycemic control with a low incidence of severe hypoglycemia compared with physician-managed titration. pubtype: Academic Journal doctype: clinical trial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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