Insulin glargine-based therapy improves glycemic control in patients with type 2 diabetes sub-optimally controlled on premixed insulin therapies

The AT.LANTUS trial recently demonstrated the efficacy and safety of insulin glargine initiation and maintenance using two different treatment algorithms in poorly controlled type 2 diabetes mellitus (T2DM). This sub-analysis investigated glycemic control and safety in 686 patients switching from premixed insulin (premix) with or without (±OADs) to once-daily glargine (±OADs/prandial insulin). A 24-week, multinational (n = 59), multicenter (n = 611), randomized study comparing two algorithms (Algorithm 1: clinic-driven titration; Algorithm 2: patient-driven titration) in four glargine ± OADs treatment groups: alone, once- (OD), twice- (BD) or >twice- (>BD) daily prandial insulin. After switching to the glargine regimen, HbA1c levels significantly improved in the overall group (9.0 ± 1.3 to 8.0 ± 1.2%; p < 0.001) and in all subgroups; fasting blood glucose levels also improved in all subgroups (overall: 167.1 ± 50.0 to 106.9 ± 27.2 mg/dL [9.3 ± 2.8 to 5.9 ± 1.5 mmol/L]; p < 0.001). The incidence of severe hypoglycemia was also low in all four subgroups (≤1.7%). Patients with T2DM switching from premix ± OADs to glargine ± OADs had significant reductions in glycemic control with a low incidence of severe hypoglycemia. The addition of prandial (OD, BD or >BD) insulin was associated with further improvements in glycemic control. These data provide support for the stepwise introduction of prandial insulin to a more physiologic basal–bolus regimen, which is under investigation.