Effectiveness and safety of insulin glargine in the therapy of complicated or secondary diabetes: clinical audit

Abstract

We wanted to assess the effectiveness and safety of glargine in the treatment of patients with type 2 diabetes mellitus in secondary failure and/or with severe comorbidities (“T2DM group”), and patients with secondary diabetes after corticosteroid and/or anticancer treatment (“secondary DM group”). We reviewed the records of patients on glargine from 1 August 2004 to 30 July 2005. The after-minus-before change in HbA_1c was the main outcome measure. At baseline, the 18 “T2DM” patients had a mean (±SD) age of 66.7±9.5 years and a diabetes duration of 13.6±10.3 years; 52.9% were male. Their fasting plasma glucose (FPG) decreased from 228.6±76.6 to 134.6±37.5, two-hour post-prandial glycaemia (2hPPG) from 268.2±10.4 to 140.6±30.8 and HbA_1c from 10.4±2.3 to 7.9±1.6%. Mean daily insulin dosage was 12.0±4.8 UI for glargine alone and 37.4±22.6 UI for basal-bolus scheme. The daily cost was € 0.75 (range € 0.31–1.15). The 24 “secondary DM” patients had a mean age of 67.0±11.0 years and a diabetes duration of 3.7±6.5 years; 54.2% were male and 91.7% had a metastatic cancer. Their FPG decreased from 222.3±108.6 to 121.5±28.7 mg/dl, 2hPPG from 259.4±108.6 to 133.0±35.0 mg/dl and HbA1c from 10.1±2.5 to 7.6±1.3%. Mean daily insulin dosage was 12.5±6.1 UI for glargine alone and 27.2±9.1 UI for basal-bolus scheme. Mean daily cost was € 0.70 (range € 0.31–1.38). One (4.2%) cancer patient withdrew from glargine because of nausea. Nine (37.5%) cancer patients had an increase in appetite after glargine therapy, including 3 end-of-life patients. No severe hypoglycaemia occurred. Insulin glargine was safe and effective in improving glycaemic control both in severe “T2DM” and in “secondary DM” patients.