J Korean Diabetes Assoc.  2007 Sep;31(5):391-401.

Therapeutic Efficacy of Combined Therapy with Once Daily Insulin Glargine and Once Daily Glimepiride in Korean Type 2 Diabetic Patients

• Park JY
• Kim HJ
• Koo BK
• Kim HJ
• Pak GS
• Han KA
• Min KW
• Kim EJ

Abstract

BACKGROUND: Once daily injection and 24 hour lasting glucose lowering effect of insulin glargine had recently changed a perception about the early insulin treatment of type 2 diabetic patients. This study was performed to investigate therapeutic efficacy of combined therapy with insulin glargine and glimepiride in Korean type 2 diabetic patients, who had received oral hypoglycemic agents (OHA) or conventional insulin therapy.
METHODS
Total of 192 patients who needed to change the previous therapy because of uncontrolled diabetes or hypoglycemia were included and followed for about 6 months. Two groups of prior treatment modality were analyzed; OHA group (n = 54, 28.1%), conventional insulin therapy group in combination with or without OHA group (n = 138, 71.9%). The primary end point was changes in HbA1c according to baseline characteristics such as prior treatment modality, HbA1C, c-peptide, duration of diabetes mellitus, body mass index and prior used conventional insulin doses. Secondary end point was the dose conversion ratio of insulin glargine to prior used insulin in patients who had one or two insulin therapy. We also evaluated the level of the patients' satisfaction on the glucose lowering effects and the convenience for use of device.
RESULTS
The differences of HbA1c according to prior treatment groups were -0.78 +/- 1.76 % in OHA group and 0.07 +/- 1.44 % in conventional insulin group with or without OHA group. The HbA1c improved better when baseline HbA1c was higher than 9%, c-peptide was higher than 0.6 ng/mL, duration of diabetes was shorter than 15 years, BMI was lower than 30 kg/m2 and prior conventional insulin dose was less than 30 IU. However, those effects were attenuated in subjects having duration of diabetes longer than 16 years, BMI higher than 30 kg/m2 and prior insulin dose more than 40 IU. Dose conversion ratio of the insulin glargine to prior insulin was 0.78 +/- 0.30 and showed a tendency to increase in patients who have prior insulin dose more than 40 IU. The scores of the patients' subjective satisfaction on insulin glargine were all high, irrespective of the changes of HbA1c.
CONCLUSIONS
Once daily injection of insulin glargine and oral ingestion of glimepiride can be recommended as one of starting insulin regimen for patients who are not adequately controlled by OHA alone or as once daily regimen for whom treated with one or two conventional insulin therapy.

Keyword

Insulin glargine; Glimepiride; Type 2 diabetes mellitus

MeSH Terms

Body Mass Index
C-Peptide
Diabetes Mellitus
Diabetes Mellitus, Type 2
Eating
Glucose
Humans
Hypoglycemia
Hypoglycemic Agents
Insulin*
Insulin Glargine
C-Peptide
Glucose
Hypoglycemic Agents
Insulin

Figure

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  Fig. 1 The changes of HbA1c (ΔHbA1c, %) according to the prior treatment modalities. *P < 0.05.

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  Fig. 2 The changes of HbA1c (ΔHbA1c, %) according to the baseline HbA1c levels. *P < 0.05.

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  Fig. 3 The changes of HbA1c (ΔHbA1c, %) according to the baseline c-peptide levels. ns = non significant.

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  Fig. 4 The changes of HbA1c (ΔHbA1c, %) according to the duration of diabetes mellitus. *P < 0.05.

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  Fig. 5 The changes of HbA1c (ΔHbA1c, %) according to the body mass index. ns = non significant.

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  Fig. 6 The changes of HbA1c (ΔHbA1c, %) according to the prior insulin doses. *P < 0.05.

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  Fig. 7 A, Prior insulin doses and glargine doses at follow up were significantly correlated by Pearsons' correlation coefficients. B, The glargine/prior insulin dose ratio had decreased significantly according to the prior insulin doses, but had a tendency to increase in the prior insulin dose of more than 40 IU.

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