When basal insulin is not enough: A dose-response relationship between insulin glargine 100 units/mL and glycaemic control

• Type of Material: Article
• Authors: Guillermo Umpierrez, Emory University; Neil Skolnik, Jefferson Health; Terry Dex, Sanofi US, Inc.; Louise Traylor, Sanofi US, Inc.; Jason Chao, Xinyi, Inc.; Charles Shaefer, University Medical Group
• Language: English
• Date: 2019-06-01
• Publisher: Wiley: 12 months
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Authors.Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1111/dom.13653
• Title of Journal or Parent Work: Diabetes, Obesity and Metabolism
• ISSN: 1462-8902
• Volume: 21
• Issue: 6
• Start Page: 1305
• End Page: 1310
• Grant/Funding Information: The authors received writing/editorial support in the preparation of this manuscript; provided by Keisha Peters, MSc of Excerpta Medica funded by Sanofi US, Inc.; This study was funded by Sanofi US, Inc.
• Keywords: WEIGHT-GAIN; TITRATION; THERAPY; CARE; basal insulin; Science & Technology; Life Sciences & Biomedicine; Endocrinology & Metabolism; GLUCOSE; postprandial; glargine; type 2 diabetes; TYPE-2; HbA1c
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Pharmacology

Abstract

Aims: A post-hoc analysis to assess the impact in people with type 2 diabetes, of increasing doses of basal insulin on glycaemic measures, body weight and hypoglycaemia. Research Design and Methods: We included data from prospective, randomized controlled treat-to-target trials of ≥24 weeks' duration in people with type 2 diabetes, uncontrolled on metformin and sulphonylureas, and treated with insulin glargine 100 units/mL (U100), who had at least six fasting plasma glucose (FPG) measurements. The impact of insulin dose on glycated haemoglobin (HbA1c) values, FPG, hypoglycaemia incidence (<3.9 mmol/L [70 mg/dL]), and body weight was analysed. A total of 458 participants from three eligible trials were included. Results: The observed relationship between higher basal insulin doses and glycaemic control was non-linear, with increasing insulin dose leading to smaller reductions in FPG and HbA1c for doses >0.3 IU/kg/d, with a plateauing effect at 0.5 IU/kg/d. Total daily dose of insulin >0.5 IU/kg/d resulted in greater weight gain, but without higher rates of hypoglycaemia, compared with insulin doses ≤0.5 IU/kg/d. Conclusions: This analysis indicates that basal insulin doses >0.5 IU/kg/d have diminishing additional impact on improving glycaemic measures, with the disadvantage of additional weight gain. Clinicians should consider anti-hyperglycaemic treatment intensification at doses approaching 0.5 IU/kg/d.