Improved glycaemic control by switching from insulin NPH to insulin glargine: a retrospective observational study

CHKS Health Economics Unit, Health Park, Cardiff, UK.
Cardiovascular Diabetology (Impact Factor: 4.02). 01/2009; 8(1):3. DOI: 10.1186/1475-2840-8-3
Source: PubMed


Insulin glargine (glargine) and insulin NPH (NPH) are two basal insulin treatments. This study investigated the effect on glycaemic control of switching from a NPH-based regimen to a glargine-based regimen in 701 patients with type 1 (n= 304) or type 2 (n= 397) diabetes, using unselected primary care data.
Data for this retrospective observational study were extracted from a UK primary care database (The Health Improvement Network). Patients were required to have at least 12 months of data before and after switching from NPH to glargine. The principal analysis was the change in HbA(1c) after 12 months treatment with glargine; secondary analyses included change in weight and total daily insulin dose. Inconsistent reporting of hypoglycemic episodes precludes reliable reporting of this outcome. Multivariate analyses were used to adjust for baseline characteristics and confounding variables.
After adjustment, both diabetic cohorts showed statistically significant reductions in mean HbA(1c) 12 months after the switch, by 0.38% (p < 0.001) in type 1 patients and 0.31% (p < 0.001) in type 2 patients. Improvement in HbA1c was positively correlated with baseline HbA(1c); patients with baseline HbA(1c) > or = 8% had reductions of 0.57% (p < 0.001) and 0.47% (p < 0.001), respectively. There was no significant change in weight or total daily insulin dose while on glargine. The majority of patients received a basal-bolus regimen prior to and after the switch (mean 79.3% before and 77.2% after switch in type 1 patients, and 80.4% and 76.8%, respectively in type 2 patients, p > 0.05).
In routine clinical practice, switching from NPH to glargine provides the opportunity for improving glycaemic control in diabetes patients inadequately controlled by NPH.

Download full-text


Available from: Andrea Longman, Oct 09, 2015
14 Reads
  • Source
    • "Usually only RCTs are included in meta-analyses [6, 7]. Thus, the effects in clinical practice have generally not been described, although there are a small number of retrospective cohort studies that have evaluated different insulin therapies clinically [8–11]. One study compared different insulin-treatments in 4,337 insulin-naïve patients with T2D initiating on NPH, PM, IG, or ID in routine clinical practice, using a retrospective database approach [The Health Improvement Network (THIN) database] [12]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the clinical effects associated with premixed insulin (PM) and basal insulin [insulin NPH (NPH), insulin glargine (IG), insulin detemir (ID)], in insulin-naïve patients with type 2 diabetes in routine clinical care. Cohort study based on data from the Swedish National Diabetes Register, including 5,077 patients, resident in the Western region of Sweden. Patients were included between 1 July 2006 and 31 December 2009 and followed for 12 months. Changes in HbA1c, body mass index (BMI) and required insulin doses were compared between the different insulin types. Covariance adjustments were performed to adjust for differences between the groups. NPH, IG, ID and PM were all associated with significant reductions in HbA1c, mean ± standard deviation ranged between 6.6 ± 17.4 mmol/mol (IG) and 8.9 ± 17.7 mmol/mol (NPH), during the 12 months of follow-up. There were no statistically significant differences in the magnitude of HbA1c reduction between the insulin types. PM required 59% higher and ID 25% higher insulin doses to achieve a similar HbA1c reduction as NPH. PM was associated with a significantly greater increase in BMI compared with NPH (p = 0.016), while IG and ID did not differ significantly from NPH. The number of patients experiencing severe hypoglycemia was low, but highest in patients treated with PM (p = 0.023). NPH, IG, ID and PM were found to be equally effective in lowering HbA1c in insulin-naïve patients with type 2 diabetes in routine clinical care in Sweden. The effects on weight, dose and treatment persistence support the recommendation of NPH or IG as first and second choices in this group of patients requiring initiation of insulin treatment.
    05/2014; 5(1). DOI:10.1007/s13300-014-0068-9
  • International Journal of Clinical Practice 09/2009; 63(10):1413-5. DOI:10.1111/j.1742-1241.2009.02170.x · 2.57 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The unique requirements of residents with diabetes in long-term care (LTC) facilities necessitate a protocol-driven, individualized approach to care. Established treatment guidelines for the management of diabetes are written with the general population in mind and, although the principles remain the same in LTC patients, clinical priorities and strategies may need to be modified, and glycemic goals should be balanced against quality of life. This article identifies and explores the institutional, staff, patient and medication-related factors that contribute to the complexity of delivering optimal diabetes care in the LTC setting, and focuses on how insulin analogs, and the pens used for their delivery, can simplify and improve care delivery while, in many cases, reducing institutional costs.
    Journal of the American Medical Directors Association 03/2010; 11(3):171-8. DOI:10.1016/j.jamda.2009.05.009 · 4.94 Impact Factor
Show more