Prospective audit of the introduction of insulin glargine (Lantus) into clinical practice in type 1 diabetes

Abstract

AbstractThe aim of this study was to test whether the reported therapeutic benefits of insulin glargine over older basal insulins are also observed in routine clinical practice.Eighty‐five people with type 1 diabetes were transferred from isophane insulin to insulin glargine between August and December 2002. Selection indications included nocturnal hypoglycaemia, fasting hyperglycaemia, the need for two isophane injections, unusual patterns of receiving insulin therapy or a personal desire to receive insulin glargine. Subject details, including glycaemic control (glucose concentrations and HbA1c levels), were recorded. Questionnaires on the frequency of all hypoglycaemic and severe hypoglycaemic episodes (requiring assistance from a third party) were recorded. Assessments on treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire [DTSQ]), quality of life and well‐being (Well‐being Questionnaire 28 [W‐BQ28]) were also performed. Subjects were re‐assessed after receiving insulin glargine for six months.Morning blood glucose concentrations and HbA1c levels fell significantly, from 9.87±0.39 to 7.93±0.29 mM (p<0.001) and from 8.24±0.12 to 7.89±0.11 (p=0.001), respectively. Total hypoglycaemic episodes remained unchanged after transferral to insulin glargine, but the number of severe hypoglycaemic episodes fell from 18 to two (p=0.002). Aggregate DTSQ scores improved from 23.7±0.85 to 28.1±0.87 (p<0.001). Perceived energy levels, diabetes specific well‐being and total well‐being each improved significantly (p<0.001, p=0.006 and p=0.032, respectively).This study indicates that the therapeutic benefits of insulin glargine reported in clinical trials in type 1 diabetes are also observed in routine clinical practice. Copyright ©2004 John Wiley & Sons, Ltd.