Long‑term evaluation of patients with type 1 diabetes mellitus treated with insulin glargine

Czech version

Authors: I. Haladová; S. Lacigová; D. Čechurová; Z. Jankovec; M. Krčma; Z. Rušavý
Authors‘ workplace: Diabetologické centrum I. interní kliniky Lékařské fakulty UK a FN Plzeň, přednosta doc. MU Dr. Martin Matějovič, Ph. D.
Published in: Vnitř Lék 2009; 55(11): 1016-1021
Category: Original Contributions

Overview

Aims of the study:
To evaluate long‑term effects of treatment with insulin analogue glargine in patients with type 1 diabetes mellitus and to follow up their further course of life. Patient sample and methodology: Retrospective evaluation of 114 patients who, from September 2004, had their basal insulin changed from NPH insulin to insulin glargine. Treatment was changed again in patients in whom a year- long treatment with insulin glargine did not bring improvement in diabetes control. The original sample was divided into 3 groups and the results compared. Compensation of diabetes (HbA_1c) after 1, 2 and 3 years and changes to basal and bolus daily insulin dose and body weight were evaluated. Results: The results are presented as median and 25th and 75th percentile. Group A – 75 patients (65%) treated for the entire evaluation period with insulin glargine. Initial HbA_1c was 7.3 (6.4– 8.2) %, 6.9 (6.0– 8.4) % after 1 year, 7.1 (5.9– 7.9) % after 2 years and 6.6 (5.5– 7.7) % after 3 years (p < 0.001). We did not identify any statistically significant changes to total, basal or bolus daily dose of insulin or statistically significant body weight increase over the evaluation period. Group B – 19 patients (17%). Switch from insulin glargine to detemir twice daily. Initial HbA_1c was 7.3 (6.9– 8.5) %, 7.4 (6.8– 8.7) % after 1 year of treatment with insulin glargine, 7.7 (7.2– 8.1) % before the treatment switch and 7.8 (6.7 – 805) % (NS) after 3 years of treatment. Daily dose of total, basal and bolus insulin did not change and, similarly, no statistically significant change to patients’ body weight was identified. Group C – 17 patients (15%). Switch from insulin glargine to an insulin pump. This group had better initial compensation with HbA_1c 6.7 (5.7– 8.6) %, HbA_1c after 1 year was 6.2 (5.6– 8.1) %, 7.0 (6.0– 7.4) % before the treatment switch and 6.3 (5.2– 7.7) % after 3 years of treatment. Total daily insulin dose: 48 (34– 60) – 38 (25– 49) IU/ day (NS). Basal daily insulin dose: 17.5 (13– 28) IU/ day – 23 (12– 32) IU/ day (NS). Bolus daily dose decreased significantly: from 25.5 (21– 33) to 15.5 (12– 22) IU/ day (p < 0.01). Body weight: 76 (71– 97) kg – 73 (72– 99) kg (NS). Only 3% of patients went back to NPH insulin. Conclusion: Insulin glargine brings improved control of diabetes. The dose of insulin glargine did not differ from NPH insulin. No statistically significant body weight increase was observed during the evaluation period.

Key words:
type 1 diabetes mellitus – diabetes control – insulin glargine

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