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Park, Kim, Koo, Kim, Pak, Han, Min, and Kim: Therapeutic Efficacy of Combined Therapy with Once Daily Insulin Glargine and Once Daily Glimepiride in Korean Type 2 Diabetic Patients
Original Articles
The Journal of Korean Diabetes Association

The Journal of Korean Diabetes Association 2007; 31(5): 391-401.

Published online: 30 September 2007

DOI: https://doi.org/10.4093/jkda.2007.31.5.391

Therapeutic Efficacy of Combined Therapy with Once Daily Insulin Glargine and Once Daily Glimepiride in Korean Type 2 Diabetic Patients

Ji Young Park, Hyo-Jeong Kim, Bo Kyung Koo, Hyun-Jin Kim, Gang Seo Pak, Kyung Ah Han, Kyung Wan Min, Eung Jin Kim

Department of Internal Medicine, Eulji University School of Medicine, Korea.

Received 18 July 2007       Accepted 14 September 2007

Copyright © 2007 Korean Diabetes Association

Abstract

Background

Once daily injection and 24 hour lasting glucose lowering effect of insulin glargine had recently changed a perception about the early insulin treatment of type 2 diabetic patients. This study was performed to investigate therapeutic efficacy of combined therapy with insulin glargine and glimepiride in Korean type 2 diabetic patients, who had received oral hypoglycemic agents (OHA) or conventional insulin therapy.

Methods

Total of 192 patients who needed to change the previous therapy because of uncontrolled diabetes or hypoglycemia were included and followed for about 6 months. Two groups of prior treatment modality were analyzed; OHA group (n = 54, 28.1%), conventional insulin therapy group in combination with or without OHA group (n = 138, 71.9%). The primary end point was changes in HbA1c according to baseline characteristics such as prior treatment modality, HbA1C, c-peptide, duration of diabetes mellitus, body mass index and prior used conventional insulin doses. Secondary end point was the dose conversion ratio of insulin glargine to prior used insulin in patients who had one or two insulin therapy. We also evaluated the level of the patients' satisfaction on the glucose lowering effects and the convenience for use of device.

Results

The differences of HbA1c according to prior treatment groups were -0.78 ± 1.76% in OHA group and 0.07 ± 1.44% in conventional insulin group with or without OHA group. The HbA1c improved better when baseline HbA1c was higher than 9%, c-peptide was higher than 0.6 ng/mL, duration of diabetes was shorter than 15 years, BMI was lower than 30 kg/m2 and prior conventional insulin dose was less than 30 IU. However, those effects were attenuated in subjects having duration of diabetes longer than 16 years, BMI higher than 30 kg/m2 and prior insulin dose more than 40 IU. Dose conversion ratio of the insulin glargine to prior insulin was 0.78 ± 0.30 and showed a tendency to increase in patients who have prior insulin dose more than 40 IU. The scores of the patients' subjective satisfaction on insulin glargine were all high, irrespective of the changes of HbA1c.

Conclusions

Once daily injection of insulin glargine and oral ingestion of glimepiride can be recommended as one of starting insulin regimen for patients who are not adequately controlled by OHA alone or as once daily regimen for whom treated with one or two conventional insulin therapy.

Keywords: Insulin glargine, Glimepiride, Type 2 diabetes mellitus

Figures and Tables

Fig. 1
The changes of HbA1c (ΔHbA1c, %) according to the prior treatment modalities. *P < 0.05.
jkda-31-391-g001
Fig. 2
The changes of HbA1c (ΔHbA1c, %) according to the baseline HbA1c levels. *P < 0.05.
jkda-31-391-g002
Fig. 3
The changes of HbA1c (ΔHbA1c, %) according to the baseline c-peptide levels. ns = non significant.
jkda-31-391-g003
Fig. 4
The changes of HbA1c (ΔHbA1c, %) according to the duration of diabetes mellitus. *P < 0.05.
jkda-31-391-g004
Fig. 5
The changes of HbA1c (ΔHbA1c, %) according to the body mass index. ns = non significant.
jkda-31-391-g005
Fig. 6
The changes of HbA1c (ΔHbA1c, %) according to the prior insulin doses. *P < 0.05.
jkda-31-391-g006
Fig. 7
A, Prior insulin doses and glargine doses at follow up were significantly correlated by Pearsons' correlation coefficients. B, The glargine/prior insulin dose ratio had decreased significantly according to the prior insulin doses, but had a tendency to increase in the prior insulin dose of more than 40 IU.
jkda-31-391-g007
Table 1
Questionnaire for evaluating patients' subjective satisfaction on insulin glargine
jkda-31-391-i001

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