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.
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.
Swinnen
Sanne G
SG
Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands. s.g.swinnen@amc.uva.nl
Dain
Marie-Paule
MP
Aronson
Ronnie
R
Davies
Melanie
M
Gerstein
Hertzel C
HC
Pfeiffer
Andreas F
AF
Snoek
Frank J
FJ
Devries
J Hans
JH
Hoekstra
Joost B
JB
Holleman
Frits
F
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
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting