title: Diabetes duration and the efficacy and safety of insulin glargine versus comparator treatment in patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  To evaluate the effect of diabetes duration on efficacy and safety in patients with type 2 diabetes mellitus (T2DM) using insulin glargine versus comparator (oral antidiabetic drugs [OADs], dietary changes, or other insulins).
  
  
  METHODS
  Data were pooled from randomized controlled clinical trials conducted in adults with T2DM with at least 24-week treatment with insulin glargine or a comparator, where predefined insulin titration algorithms were utilized to achieve fasting plasma glucose (FPG) concentrations of ≤100 mg/dL. Glycated hemoglobin A1C (A1C), FPG, and insulin dose and safety (hypoglycemia) outcomes were analyzed.
  
  
  RESULTS
  Nine studies were included in the analysis of 2,930 patients. Patients with shorter duration of diabetes were more likely to have greater reductions in A1C compared with those who had longer-duration disease (P<.0001). Disease duration did not affect change in FPG concentrations (P = .9017), but lower weight-adjusted insulin dose was correlated with longer-duration disease (P<.0001). Patients with longer-duration diabetes had increased risks of symptomatic hypoglycemia, confirmed hypoglycemia (self-monitored blood glucose <50 mg/dL and <70 mg/dL), and nocturnal hypoglycemia (all P<.001). No significant relationship was found between severe hypoglycemia and duration of diabetes. However, treatment with insulin glargine lowered A1C values more effectively than comparator treatments with fewer hypoglycemic episodes.
  
  
  CONCLUSIONS
  Patients with shorter-duration T2DM better achieved target A1C levels and had less hypoglycemia than those with longer disease duration. Insulin glargine was associated with reduced A1C and fewer hypoglycemic events than comparators, regardless of disease duration.
authors.affiliation: University of Colorado Denver, Aurora, Colorado.
authors.forename: Satish K
authors.initials: SK
authors.lastname: Garg
authors.affiliation: Sanofi US, Inc., Bridgewater, New Jersey.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Aurand
authors.affiliation: Medpace, Cincinnati, Ohio.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Rimler
authors.affiliation: Scripps Clinic, La Jolla, California.
authors.forename: George E
authors.initials: GE
authors.lastname: Dailey
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000069036:Insulin Glargine / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069036:Insulin Glargine; C517652:hemoglobin A1c protein, human