Higher insulin glargine dose may be optimal in type 1 diabetes
medwireNews: A 300 U/mL dose of insulin glargine provides more consistent glycemic control than a 100 U/mL dose, potentially allowing greater flexibility of dosing schedule, shows an exploratory study.
The findings, obtained in 59 patients with type 1 diabetes using continuous glucose monitoring, extend those of previous pharmacokinetic/pharmacodynamic euglycemic clamp studies. The participants were randomly assigned to use insulin glargine 300 or 100 U/mL in the morning or evening for 8 weeks, after which they remained on the same dose but crossed over to the alternative injection time for a further 8 weeks.
Glycemic control during the last 2 weeks of each period did not differ according to dose, with the time spent within target blood glucose range (80–140 mg/dL) being 31.8% and 31.0% for insulin glargine 300 and 100 U/mL, respectively. This was true whether insulin was injected in the morning or in the evening, and there was “no meaningful difference” in the amount of time patients spent in hyperglycemia or hypoglycemia.
Although glucose variability as a whole did not differ between doses, Richard Bergenstal (International Diabetes Center at Park Nicollet, Minneapolis, Minnesota, USA) and study co-authors found marked differences between the 24-hour glucose profiles for the two doses, with patients taking the 300 U/mL dose having smoother profiles.
In particular, the glucose profiles for insulin glargine 300 U/mL taken in the morning and the evening were “nearly superimposable,” whereas patients injecting a 100 U/mL dose in the morning had larger excursions than those who injected the same dose in the evening.
“The similar findings in the morning and evening injection groups for [insulin glargine 300 U/mL] suggest the potential for flexibility to select an injection time (morning or evening) without compromising clinical benefits,” write the researchers in Diabetes Care.
This should allow diabetes patients “to select their insulin injection schedule according to their lifestyle to reduce the burden of therapy,” they say.
The team also notes that there “would be value in a clinical trial exploring whether people currently using [glargine 100 U/mL] twice daily could be adequately controlled with [glargine 300 U/mL] once daily.”
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