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      Improving Type 2 Diabetes Management in General Practice Using a Second-Generation Basal Insulin Analogue Insulin Glargine 300 U/mL: A  Practical Guide

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          Abstract

          Type 2 diabetes management can be improved by the use of second-generation basal insulin analogues as the first choice on commencement of insulin, in this instance focussing on insulin glargine 300 U/mL (Gla-300). The clinical application of the use of Gla-300 include advantages such as less intra- and interpatient variability in glucose control resulting in rather less hypoglycaemia, longer duration of action and greater flexibility in the timing of administration thus suiting a wide range of patient presentations.

          Funding : Sanofi Australia.

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          Clinical inertia to insulin initiation and intensification in the UK: A focused literature review.

          Kamlesh Khunti, David Millar-Jones (2017)
          Achieving tight glycaemic control early following the diagnosis of type 2 diabetes is key to optimising clinical outcomes, yet many patients and clinicians are reluctant to initiate and intensify insulin therapy. Reasons for this arise primarily from a lack of time, clinical expertise and patient understanding. However, meaningful progress can be achieved with self-management educational programmes soon after diagnosis. Clinician education and training, along with easy-to-use and well-tolerated therapies (for example, those carrying a low risk of hypoglycaemia and/or avoiding weight gain), may also increase the likelihood of patient adherence.
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            Glycaemic control and hypoglycaemia with new insulin glargine 300 U/ml versus insulin glargine 100 U/ml in people with type 2 diabetes using basal insulin and oral antihyperglycaemic drugs: the EDITION 2 randomized 12‐month trial including 6‐month extension

            H Yki-Järvinen, R Bergenstal, G. Bolli … (2015)
            Aims To compare the efficacy and safety of new insulin glargine 300 U/ml (Gla‐300) with insulin glargine 100 U/ml (Gla‐100) over 12 months of treatment in people with type 2 diabetes using basal insulin and oral antihyperglycaemic drugs (OADs). Methods EDITION 2 (NCT01499095) was a randomized, 6‐month, multicentre, open‐label, two‐arm, phase IIIa study investigating once‐daily Gla‐300 versus Gla‐100, plus OADs (excluding sulphonylureas), with a 6‐month safety extension. Results Similar numbers of participants in each group completed 12 months of treatment [Gla‐300, 315 participants (78%); Gla‐100, 314 participants (77%)]. The reduction in glycated haemoglobin was maintained for 12 months with both treatments: least squares (LS) mean (standard error) change from baseline −0.55 (0.06)% for Gla‐300 and −0.50 (0.06)% for Gla‐100; LS mean difference −0.06 [95% confidence interval (CI) −0.22 to 0.10)%]. A significant relative reduction of 37% in the annualized rate of nocturnal confirmed [≤3.9 mmol/l (≤70 mg/dl)] or severe hypoglycaemia was observed with Gla‐300 compared with Gla‐100: rate ratio 0.63 [(95% CI 0.42–0.96); p = 0.031], and fewer participants experienced ≥1 event [relative risk 0.84 (95% CI 0.71–0.99)]. Severe hypoglycaemia was infrequent. Weight gain was significantly lower with Gla‐300 than Gla‐100 [LS mean difference −0.7 (95% CI −1.3 to −0.2) kg; p = 0.009]. Both treatments were well tolerated with a similar pattern of adverse events (incidence of 69 and 60% in the Gla‐300 and Gla‐100 groups). Conclusions In people with type 2 diabetes treated with Gla‐300 or Gla‐100, and non‐sulphonylurea OADs, glycaemic control was sustained over 12 months, with less nocturnal hypoglycaemia in the Gla‐300 group.
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              Clinical perspectives from the BEGIN and EDITION programmes: Trial-level meta-analyses outcomes with either degludec or glargine 300 U/mL vs glargine 100 U/mL in T2DM

              J Rosenstock, E. Boëlle-Le Corfec, R Ritzel … (2018)
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                Author and article information

                Contributors
                Gary Deed:
                ORCID: http://orcid.org/0000-0001-6914-0982
                drgarydeed@outlook.com
                Journal
                Journal ID (nlm-ta): Diabetes Ther
                Journal ID (iso-abbrev): Diabetes Ther
                Title: Diabetes Therapy
                Publisher: Springer Healthcare (Cheshire )
                ISSN (Print): 1869-6953
                ISSN (Electronic): 1869-6961
                Publication date (Electronic): 21 October 2019
                Publication date PMC-release: 21 October 2019
                Publication date (Print): December 2019
                Volume: 10
                Issue: 6
                Pages: 1987-1994
                Affiliations
                [1 ]Mediwell Medical Clinic, Brisbane, QLD Australia
                [2 ]GRID grid.1011.1, ISNI 0000 0004 0474 1797, James Cook University, ; Townsville, QLD Australia
                [3 ]GRID grid.1029.a, ISNI 0000 0000 9939 5719, Western Sydney University, ; Sydney, NSW Australia
                [4 ]GRID grid.460731.7, ISNI 0000 0004 0413 7151, Ipswich Hospital, ; Brisbane, QLD Australia
                [5 ]Trigg Health Care Centre, Perth, WA Australia
                Author information
                http://orcid.org/0000-0001-6914-0982
                Article
                Publisher ID: 704
                DOI: 10.1007/s13300-019-00704-0
                PMC ID: 6848330
                PubMed ID: 31637635
                SO-VID: 2120af4f-358d-4857-aa2a-7ed2cdf68586
                Copyright © © The Author(s) 2019
                History
                Date received : 2 September 2019
                Funding
                Funded by: Sanofi Australia
                Categories
                Subject: Practical Approach
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: case vignettes,practical guide,second-generation insulin analogues,type 2 diabetes
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: case vignettes, practical guide, second-generation insulin analogues, type 2 diabetes

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