When patients with type 2 diabetes that is no longer controlled with oral medications begin insulin therapy, it is better to add once-daily glargine insulin to the oral regimen than to switch to a shorter-acting insulin that needs to be injected twice a day, according to a report in the journal Diabetes Care.

There is currently no consensus on how and when insulin therapy should be started in type 2 diabetic patients, the authors explain, and treatment regimens vary from place to place.

Unlike type 1 diabetes, previously referred to as juvenile-onset diabetes, which is a more severe disease, type 2 diabetes primarily develops in adults, begins gradually, progresses slowly and is often effectively controlled with oral medications.

Dr. Hans U. Janka from Zentralkrankenhaus in Bremen-Nord, Germany, and colleagues compared two commonly used regimens for initiating insulin therapy: adding once-daily glargine insulin to oral antidiabetic therapy, or replacing oral antidiabetic therapy with twice-daily shorter-acting insulin.

The study group included 364 type 2 diabetes who had never been treated with insulin. The patients were randomly assigned to one of the two treatment groups.

The improvement in glycosylated hemoglobin, a measure of glucose control, over the 24-week study was greater with glargine plus oral therapy than with shorter-acting insulin, the authors report.

Similarly, fasting blood glucose and average daily glucose levels showed significantly greater improvement with glargine plus oral therapy compared with treatment with shorter-acting insulin, the report indicates. Moreover, the researchers note, fewer glargine plus oral therapy patients experienced episodes of low blood sugar.

A similar number of adverse events was experienced by patients in the two treatment groups.

These findings show that for type 2 diabetes patients with poor control over blood sugar with oral therapy alone, the addition of a single injection of insulin glargine to oral medications can provide more effective glycemic control than switching from oral medications to twice-daily insulin injections, the authors conclude.

“The glargine plus oral antidiabetic therapy regimen in this study required only a single daily injection and a single before-breakfast glucose test to guide therapy and, therefore, should be easy to use in clinical practice,” the investigators add.

Diabetes Care, February 2005.