A insulina glargina (LANTUS) é um análogo da insulina basal utilizada uma vez ao dia com um tempo de ação de 24h que provê controle glicêmico efetivo com reduzido risco de hipoglicemia (particularmente noturna) comparada com a insulina NPH em pacientes com diabetes tipo 2. Um recente estudo mostrou que mais pacientes com insulina glargina alcançaram níveis de HbA(1c) ≤ 7,0% sem hipoglicemia noturna confirmada comparada com insulina NPH.
Neste estudo, recentemente publicado na revista Diabetes Care, pesquisadores americanos avaliaram o risco de hipoglicemia em uma metanálise de estudos controlados de design semelhantes para insulina glargina versus insulina NPH uma ou duas vezes ao dia em pacientes adultos com diabetes tipo 2. Todos os estudos tinham uma duração de 24-28 semanas, exceto um estudo com 52 semanas, do qual foram utilizados dados interinos de 20 semanas.
As demografias dos pacientes foram similares entre os grupos de insulina glargina (n = 1142) e NPH (n = 1162). A proporção de pacientes alcançando HbA(1c) alvo (≤ 7,0%) foi similar entre os pacientes tratados com insulina glargina e NPH (30,8 e 32,1%, respectivamente). Houve uma redução significante consistente do risco de hipoglicemia associado com insulina glargina, comparado com insulina NPH, em termos de hipoglicemia sintomática em geral (11%; p = 0,0006) e noturna (26%; p < 0,0001). Mais notavelmente, o risco de hipoglicemia grave e hipoglicemia noturna grave foram reduzidos com insulina glargina em 46% (p = 0,0442) e 59% (p = 0,0231), respectivamente.
Os autores concluíram que esses resultados confirmaram que a insulina glargina aplicada uma vez ao dia reduz o risco de hipoglicemia comparada com a insulina NPH, a qual pode facilitar tratamentos mais agressivos com insulina para um HbA(1c) alvo ≤ 7,0% em pacientes com diabetes tipo 2.
Reduced hypoglycemia risk with insulin glargine: a meta-analysis comparing insulin glargine with human NPH insulin in type 2 diabetes - Diabetes Care 2005; 28(4):950-5.
Diabetes Care 28:950-955, 2005
© 2005 by the American Diabetes Association, Inc.
Reviews/Commentaries/ADA Statements
Meta-Analysis |
Reduced Hypoglycemia Risk With Insulin Glargine
A meta-analysis comparing insulin glargine with human NPH insulin in type 2 diabetes
Julio Rosenstock, MD1, George Dailey, MD2, Massimo Massi-Benedetti, MD3, Andreas Fritsche, MD4, Zhengning Lin, PHD5 and Alan Salzman, MD5
1 Dallas Diabetes and Endocrine Center, Dallas, Texas
2 Department of Medicine, University of California, San Diego, La Jolla, California
3 Department of Medicine, University of Perugia, Perugia, Italy
4 Medizinische Universitätsklinik, Tübingen, Germany
5 Aventis Pharma, Bridgewater, New Jersey
Address correspondence and reprint requests to Julio Rosenstock, MD, Dallas Diabetes and Endocrine Center, Medical City Dallas, 7777 Forest Ln., Suite C-618, Dallas, TX 75230. E-mail: juliorosenstock@dallasdiabetes.com
ABSTRACT
OBJECTIVE—Insulin glargine (LANTUS) is a once-daily basal insulin analog with a smooth 24-h time-action profile that provides effective glycemic control with reduced hypoglycemia risk (particularly nocturnal) compared with NPH insulin in patients with type 2 diabetes. A recent "treat-to-target" study has shown that more patients on insulin glargine reached HbA1c levels 
7.0% without confirmed nocturnal hypoglycemia compared with NPH insulin. We further assessed the risk for hypoglycemia in a meta-analysis of controlled trials of a similar design for insulin glargine versus once- or twice-daily NPH insulin in adults with type 2 diabetes.
RESEARCH DESIGN AND METHODS—All studies were 24–28 weeks long, except one 52-week study, for which interim 20-week data were used.
RESULTS—Patient demographics were similar between the insulin glargine (n = 1,142) and NPH insulin (n = 1,162) groups. The proportion of patients achieving target HbA1c (7.0%) was similar between insulin glargine–and NPH insulin–treated patients (30.8 and 32.1%, respectively). There was a consistent significant reduction of hypoglycemia risk associated with insulin glargine, compared with NPH insulin, in terms of overall symptomatic (11%; P = 0.0006) and nocturnal (26%; P < 0.0001) hypoglycemia. Most notably, the risk of severe hypoglycemia and severe nocturnal hypoglycemia were reduced with insulin glargine by 46% (P = 0.0442) and 59% (P = 0.0231), respectively.
CONCLUSIONS—These results confirmed that insulin glargine given once daily reduces the risk of hypoglycemia compared with NPH insulin, which can facilitate more aggressive insulin treatment to a HbA1c target of 7.0% in patients with type 2 diabetes.
Abbreviations: ITT, intent to treat
