title: A 24-week, randomized, treat-to-target trial comparing initiation of insulin glargine once-daily with insulin detemir twice-daily in patients with type 2 diabetes inadequately controlled on oral glucose-lowering drugs.
abstract: OBJECTIVE
  To determine whether glargine is noninferior to detemir regarding the percentage of patients reaching A1C <7% without symptomatic hypoglycemia <or=3.1 mmol/l.
  
  
  METHODS
  In this 24-week trial, 973 insulin-naive type 2 diabetic patients on stable oral glucose-lowering drugs with A1C 7.0-10.5% were randomized to glargine once daily or detemir twice daily. Insulin doses were systematically titrated. RESULTS 27.5 and 25.6% of patients reached the primary outcome with glargine and detemir, respectively, demonstrating the noninferiority of glargine. Improvements in A1C were -1.46 +/- 1.09% for glargine and -1.54 +/- 1.11% for detemir (P = 0.149), with similar proportions of patients achieving A1C <7% (P = 0.254) but more detemir-treated patients reaching A1C <6.5% (P = 0.017). Hypoglycemia risk was similar. Weight gain was higher for glargine (difference: 0.77 kg, P < 0.001). Glargine doses were lower than detemir doses: 43.5 +/- 29.0 vs. 76.5 +/- 50.5 units/day (P < 0.001).
  
  
  CONCLUSIONS
  In insulin-naive type 2 diabetic patients, glargine reached similar control as detemir, with more weight gain, but required significantly lower doses.
authors.affiliation: Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands. s.g.swinnen@amc.uva.nl
authors.forename: Sanne G
authors.initials: SG
authors.lastname: Swinnen
authors.forename: Marie-Paule
authors.initials: MP
authors.lastname: Dain
authors.forename: Ronnie
authors.initials: R
authors.lastname: Aronson
authors.forename: Melanie
authors.initials: M
authors.lastname: Davies
authors.forename: Hertzel C
authors.initials: HC
authors.lastname: Gerstein
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Pfeiffer
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Snoek
authors.forename: J Hans
authors.initials: JH
authors.lastname: Devries
authors.forename: Joost B
authors.initials: JB
authors.lastname: Hoekstra
authors.forename: Frits
authors.initials: F
authors.lastname: Holleman
mesh_terms: D000284:Administration, Oral; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism; D004334:Drug Administration Schedule; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000494:pharmacology; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; D016896:Treatment Outcome; D015430:Weight Gain / Q000187:drug effects
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting