Glargine is superior to neutral protamine Hagedorn for improving glycated haemoglobin and fasting blood glucose levels during intensive insulin therapy

  1. G. R. Fulcher,
  2. R. E. Gilbert,
  3. D. K. Yue

Article first published online: 15 AUG 2005

DOI: 10.1111/j.1445-5994.2005.00902.x

Issue

Internal Medicine Journal

Internal Medicine Journal

Volume 35, Issue 9, pages 536–542, September 2005

Additional Information

How to Cite

Fulcher, G. R., Gilbert, R. E. and Yue, D. K. (2005), Glargine is superior to neutral protamine Hagedorn for improving glycated haemoglobin and fasting blood glucose levels during intensive insulin therapy. Internal Medicine Journal, 35: 536–542. doi: 10.1111/j.1445-5994.2005.00902.x

Author Information

  1. 1 Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital and 3Diabetes Centre, Royal Prince Alfred Hospital and Discipline of Medicine, University of Sydney, Sydney, New South Wales, and 2Department of Medicine, University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia

*Correspondence to: Dr Greg R. Fulcher, Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital, St Leonards 2065, New South Wales, Australia. Email: gfulcher@med.usyd.edu.au

Publication History

  1. Issue published online: 15 AUG 2005
  2. Article first published online: 15 AUG 2005
  3. Received 9 August 2004;accepted 15 September 2004

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Keywords:

  • glargine;
  • glycaemic control;
  • basal–bolus;
  • glycated haemoglobin;
  • fasting blood glucose

Abstract

Aim: To compare glycaemic control and symptomatic hypoglycaemia rates with glargine versus neutral protamine Hagedorn (NPH) in poorly controlled type 1 diabetes patients.

Methods: Patients (n = 125) received preprandial insulin lispro and either glargine (n = 62) or NPH (n = 63) at bedtime for 30 weeks in a multicentre, randomized, single-blind (a blinded investigator made titration decisions) study. Basal insulin dosage was titrated to achieve fasting blood glucose (FBG) values <5.5 mmol/L.

Results:  Baseline characteristics were similar for the two groups (mean diabetes duration 17.5 ± 10.1 years) except mean glycated haemoglobin (HbA1c), which was lower in the glargine versus NPH group (9.2 ± 1.1% vs 9.7 ± 1.3%; P < 0.02). At end-point, mean HbA1c was 8.3 versus 9.1% for the glargine versus NPH groups. Adjusted least-squares mean (LSM) change from baseline was –1.04 versus –0.51%, a significant treatment benefit of 0.53% for HbA1c in favour of glargine (P < 0.01). Mean baseline FBG were similar for the glargine and NPH groups (11.2 vs 11.4 mmol/L). The means for end-point FBG were 7.9 versus 9.0 mmol/L. Adjusted LSM change from baseline was –3.46 versus –2.34 mmol/L, with a significant difference of 1.12 mmol/L in favour of glargine (P < 0.05). There were similar total numbers of daytime mild, moderate or severe hypoglycaemia episodes in the two treatment arms. However, significantly fewer moderate or severe nocturnal hypoglycaemic episodes were observed in the glargine group (P = 0.04 and P = 0.02).

Conclusion:  Glargine is superior to NPH for improving HbA1c and FBG levels during intensive insulin therapy in patients with type 1 diabetes, and is associated with less severe nocturnal hypoglycaemia. (Intern Med J 2005; 35: 536–542)

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