title: Intensification of diabetes treatment with long-acting insulin shows no benefit over other diabetes treatment.
abstract: BACKGROUND
  Control of diabetes is challenging, and frequent treatment changes are needed.
  
  
  OBJECTIVE
  To study the effect of the recommendation to start insulin glargine or insulin determir (long-acting insulin treatment, LAI) at discharge from hospital, on glucose control in the community setting.
  
  
  METHODS
  Included were type II diabetes patients who were referred to and received a consultation from the hospital diabetes clinic during their hosptialization, as part of a routine consultation for diabetes management. During the visit, all patients were recommended long-acting insulin-based treatment, as inpatient treatment and at discharge. Follow-up was done by the primary physician in the community or by a community-based diabetes clinic. Glycosylated hemoglobin, glucose levels and other laboratory tests were obtained from the community health records before hospitalization and 6-12 months later. Medical treatment was ascertained by reviewing the actual usage of prescriptions.
  
  
  RESULTS
  Eighty patients (58% males, mean age 64.1 +/- 12.7 years) were included in the analysis. HbA1c levels were 10.1 +/- 2.4% before admission, but improved significantly at follow-up (8.6 +/- 2.2%, P < 0.001). Seventy-one percent of the patients were taking the LAI treatment and the rest were using non-LAI medications. Changes in diabetes control were similar between the LAI and non-LAL groups (HbA1c was reduced by 1.5 +/- 3.2% and 1.9 +/- 3.1% respectively). The rate of repeated admissions was also similar, averaging at 1.3 admissions for both groups, the minority of which were related to glucose control.
  
  
  CONCLUSIONS
  Insulin glargine or determir-based treatment does not show any superiority over other anti-diabetes treatment. It is our opinion that this treatment should be used as tailored therapy and should not be recommended routinely to all patients.
authors: Diabetes Clinic, Wolfson Medical Center, Holon, Israel.
authors: Julio
authors: J
authors: Wainstein
authors: Eyal
authors: E
authors: Leibovitz
authors: Tuvia
authors: T
authors: Segal
authors: Dov
authors: D
authors: Gavish
mesh_terms: D001786:Blood Glucose / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000187:drug effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000097:blood / Q000627:therapeutic use*; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000097:blood / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting