Insulin glargine as add-on therapy to oral hypoglycaemic agents to achieve target fasting plasma glucose levels in type 2 diabetes patients in an Indian setup

Background: Optimal dosing of basal insulin is needed to achieve target fasting plasma glucose and to avoid hypoglycemia on the other hand in patients of type 2 diabetes inadequately controlled on oral hypoglycemic agents. The present study evaluated the efficacy of addition of basal insulin, insulin glargine to a combination of sulfonylureas and metformin, in inadequately controlled type 2 diabetes patients over a 12-week period. Methodology: This is a prospective study done in 40 type 2 diabetics having uncontrolled diabetes as evidenced by fasting plasma glucose >140 mg/dL and HbA1c >8%. Patients were started on insulin glargine 10 units at bed time and uptitrated as per plasma glucose values performed weekly and once euglycemia was achieved, fortnightly monitoring was performed. The fasting plasma glucose values were compared at 12 weeks with the baseline. Results: Average age of the study population was 56.35 +/- 6.77 years with duration of diabetes being 11.68 +/- 5.70 years. At presentation, the average fasting and postprandial plasma glucose values were 318.55 +/- 75.01 and 378.9 +/- 76.29 mg/dL, respectively. At 12 weeks, the average fasting and postprandial plasma glucose values were 115.6 +/- 11.1 mg/dL and 188 +/- 15.2 mg/dL respectively. Average dose requirement of insulin glargine was 33.55 +/- 11.94 units. The average insulin glargine dose requirement per kilogram body weight was 0.48 +/- 0.17 units/kg body weight. The range of insulin dose was 0.23-0.96 units/kg body weight. Conclusion: Bedtime basal insulin in form of insulin glargine is effective in achieving euglycemia in patients of type 2 diabetes who are inadequately controlled on oral hypoglycemic agents. Patient-specific dose titration is needed to achieve target fasting plasma glucose levels. Copyright (C) 2014, Indian Journal of Medical Specialities. Published by Reed Elsevier India Pvt. Ltd. All rights reserved.