Improved glycemic control without an increase in severe hypoglycemic episodes in intensively treated patients with type 1 diabetes receiving morning, evening, or split dose insulin glargine

Garg, Satish K.; Gottlieb, Peter A.; Hisatomi, Mary E.; D’Souza, Anna; Walker, Andrew J.; Izuora, Kenneth E.; Chase, H.Peter

doi:10.1016/j.diabres.2004.02.008

« Previous Next »Diabetes Research and Clinical Practice
Volume 66, Issue 1 , Pages 49-56, October 2004

Improved glycemic control without an increase in severe hypoglycemic episodes in intensively treated patients with type 1 diabetes receiving morning, evening, or split dose insulin glargine

Satish K. Garg
- Department of Medicine, University of Colorado Health Sciences Center, Denver, CO 80262, USA
- Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO, USA
- Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Campus Box B-140, Denver, CO 80262, USA
- Corresponding author. Tel.: +1-303-315-6396; fax: +1-303-315-4124.
Peter A. Gottlieb
- Department of Medicine, University of Colorado Health Sciences Center, Denver, CO 80262, USA
- Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO, USA
- Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Campus Box B-140, Denver, CO 80262, USA
Mary E. Hisatomi
- Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Campus Box B-140, Denver, CO 80262, USA
Anna D’Souza
- West Virginia University, P.O. Box 6201, Morgantown, WV 26506, USA
Andrew J. Walker
- Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Campus Box B-140, Denver, CO 80262, USA
Kenneth E. Izuora
- Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Campus Box B-140, Denver, CO 80262, USA
H.Peter Chase
- Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO, USA
- Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Campus Box B-140, Denver, CO 80262, USA

Received 24 July 2003; received in revised form 8 December 2003; accepted 6 February 2004. published online 19 August 2004.

Abstract

Objective: To see if insulin glargine improves glycemic control in a clinical setting. Research design and methods: A questionnaire and electronic database were used to assess glycemic parameters for 292 type 1 diabetic subjects taking ≥4 injections per day and receiving glargine as their only long-acting basal insulin for at least 6 months. Sixty-three subjects were taking glargine in the morning, 125 were taking glargine in the evening, and 104 were splitting the glargine dose between the morning and evening. Results: The mean (±S.D.) age and duration of diabetes were 32±10 years and 15.9±10.3 years, respectively. The mean (±S.E.M.) durations of treatment with glargine were 13.1±0.6 months, 12.2±0.4 months, and 14.3±0.5 months for the morning, evening, and split treatment groups, respectively (P<0.01). The A1C values improved significantly from baseline for the evening and the split dosage groups or when all groups were combined. The mean basal insulin dose was significantly reduced at the end of the study in all the three groups from baseline with no change in the short-acting insulin dose. The number of severe hypoglycemic episodes decreased from 379 in the year prior to glargine treatment to 167 in the post-glargine year. The weight gain was significantly higher in the group that took the split glargine dose (P<0.01). Conclusions: Similar or improved glycemic control was achieved by administering glargine in the morning, evening, or using a split dose without any further increase in severe hypoglycemic episodes. Splitting the glargine dose did not offer any advantages in glycemic control parameters.

Abbreviations: A1C, glycosylated hemoglobin, DCCT, diabetes control and complications trial, NPH, neutral protamine hagedorn insulin

Keywords: Insulin glargine, Morning, evening, or split dose glargine treatment, Type 1 diabetes, Severe hypoglycemic episodes, A1C values