Once-Daily Insulin Shot Proves Effective in Study

THURSDAY, March 27 (HealthDay News) -- Researchers report that a
once-daily shot of insulin appears to control blood sugar levels in people
with type 2 diabetes just as well as injecting insulin three times a
day.

The once-a-day formulation, known as insulin glargine (Lantus), is
already on the market, as is insulin lispro (Humalog), which is taken with
meals. The new, international study found more patient satisfaction with
the glargine.

"This study just confirms that insulin is effective and there are good
reasons to use insulin if oral agents are not working," said Dr. Sue
Kirkman, vice president of clinical affairs at the American Diabetes
Association. "It%26#39;s certainly not that one is good and one is bad."

The new study did show slight benefits for insulin glargine in terms of
patient satisfaction and low blood sugar. But the study was funded by
Lantus%26#39; maker, Sanofi Aventis, and other studies funded by makers of other
insulin formulations have found slight benefits for those products, too,
Kirkman noted.

The results are published in the March 29 edition of The
Lancet.

Maintaining strict blood sugar control is critical to avoid the
complications of diabetes, which can include blindness, kidney failure,
and even amputations.

The American Diabetes Association recommends that concentrations of
hemoglobin A1c -- a measure of blood sugar control -- remain below 7
percent. Lower levels can substantially reduce the risk of diabetes
complications.

Type 2 diabetes -- often linked to being overweight -- is caused by the
body%26#39;s inability to properly use the hormone insulin, which transports
blood sugar to the cells for energy. Type 1 diabetes, which is less
common, results from the body%26#39;s failure to produce insulin.

Oral medications, along with lifestyle changes such as improved diet
and exercise, can often control type 2 diabetes in the beginning. But, in
many cases, insulin needs to be added to a patient%26#39;s regimen as the
disease progresses.

"Diabetes is a worsening epidemic worldwide and studies examining
glycemic control are very important," said Dr. Spyros Mezitis, an
endocrinologist at Lenox Hill Hospital in New York City. "Diabetes is not
well controlled in many patients and insulin is not used early enough in
the treatment algorithm for type 2 diabetes to achieve maximal
benefit."

Lantus is known as a "basal" insulin analogue, meaning it is given once
a day either in the morning or at night; it lasts for about 24 hours.
Insulin lispro is shorter-acting and is administered with meals.

For the new study, more than 400 men and women with type 2 diabetes
that was poorly controlled by oral medication were randomly assigned to
receive either Lantus or Humalog. The trial, conducted at 69 study sites
in Europe and Australia, lasted 44 weeks. All participants continued to
take oral medications.

Blood sugar control was about equivalent in the two groups, with a
decrease of 1.7 percent in the Lantus group and 1.9 percent in the Humalog
group.

Lantus was associated with a lower risk of low blood sugar. It also
offered the advantages of fewer injections and less blood glucose
monitoring throughout the day (only once before breakfast). People taking
Lantus also experienced less weight gain, the study authors said.

Certainly, Lantus seems to present another, viable option for people
with type 2 diabetes, and one that fits with current treatment
recommendations, Kirkman said.

"The American Diabetes Association has a consensus treatment algorithm
for type 2 diabetes and insulin is suggested as a second- or third-line
treatment," she said. "The suggestion is to start with basal insulin, but
that%26#39;s really primarily because it tends to be easier to convince a
patient to go on one shot a day."

Dr. Juan Castro, director of the Texas A%26M Health Science Center
Coastal Bend Health Education Center, said, "I don%26#39;t think it [the new
study] is going to revolutionize what we%26#39;re doing but, to clinicians, it
really supports what we have seen in the Hispanic population. Historically
there has been a lot of resistance with Hispanic patients to accept the
idea of being on insulin. This basal insulin gives us a good transition to
help patients accept insulin because it%26#39;s only once a day. If, two to
three months later, we need to give them lispro, it%26#39;s easier for them to
accept it."

More information

The American Diabetes Association has more on insulin.