A 24-week, randomized, treat-to-target trial comparing initiation of insulin glargine once-daily with insulin detemir twice-daily in patients with type 2 diabetes inadequately controlled on oral glucose-lowering drugs

Sanne G Swinnen, Marie-Paule Dain, Ronnie Aronson, Melanie Davies, Hertzel C Gerstein, Andreas F Pfeiffer, Frank J Snoek, J Hans Devries, Joost B Hoekstra, Frits Holleman, Sanne G Swinnen, Marie-Paule Dain, Ronnie Aronson, Melanie Davies, Hertzel C Gerstein, Andreas F Pfeiffer, Frank J Snoek, J Hans Devries, Joost B Hoekstra, Frits Holleman

Abstract

Objective: To determine whether glargine is noninferior to detemir regarding the percentage of patients reaching A1C <7% without symptomatic hypoglycemia <or=3.1 mmol/l.

Research design and methods: In this 24-week trial, 973 insulin-naive type 2 diabetic patients on stable oral glucose-lowering drugs with A1C 7.0-10.5% were randomized to glargine once daily or detemir twice daily. Insulin doses were systematically titrated. RESULTS 27.5 and 25.6% of patients reached the primary outcome with glargine and detemir, respectively, demonstrating the noninferiority of glargine. Improvements in A1C were -1.46 +/- 1.09% for glargine and -1.54 +/- 1.11% for detemir (P = 0.149), with similar proportions of patients achieving A1C <7% (P = 0.254) but more detemir-treated patients reaching A1C <6.5% (P = 0.017). Hypoglycemia risk was similar. Weight gain was higher for glargine (difference: 0.77 kg, P < 0.001). Glargine doses were lower than detemir doses: 43.5 +/- 29.0 vs. 76.5 +/- 50.5 units/day (P < 0.001).

Conclusions: In insulin-naive type 2 diabetic patients, glargine reached similar control as detemir, with more weight gain, but required significantly lower doses.

Trial registration: ClinicalTrials.gov NCT00405418.

Figures

Figure 1
Figure 1
A1C levels (A) and daily insulin doses (B) during the 24-week treatment period.

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Source: PubMed

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