Endocrine Abstracts

Background and Aims: Insulin glargine is a long acting insulin analog that mimics normal basal insulin secretion without pronounced peaks. The aim of this study was to compare insulin glargine with NPH insulin for basal insulin supply in patients with type 1 diabetes.

Materials and Methods: A total of 48 type 1 diabetics (mean age 27 yr, BMI 23,1 kg/m²) on long term intensive insulin therapy (IIT) were randomized into 3 different regimens of basal insulin substitution: 1. continuation of NPH insulin once daily at bedtime with more intensive self monitoring (n=15); 2. NPH insulin twice daily (n=15); 3.insulin glargine once daily (n=18). Meal time insulin aspart was continued in all groups.

Results: Fasting blood glucose (FBG) was lower in glargine group (7.3±1.2 mmol/l)than in twice daily NPH group (7.5±1.9 mmol/L) but without significant difference. FBG was significant higher in once daily NPH group (8.4±2.1 mmol/l; P<0.05). HbA1c after 3 months did not change in one daily NPH group, but decreased in glargine group (from 7.7 ±1.2 to 6.9±0.5%) as well as with NPH insulin twice daily (from 7.8±1.0 to 7.0±1.2%). Total daily insulin doses were similar in all groups but only in glargine group there was no an increase of basal and decrease of meal related insulin doses. Frequency of mild hypoglycaemia was significantly lower in glargine group (6.7±1.0) than in both NPH groups (9.5±1.7 in twice daily NPH group and 8.2±2.4 in other NPH group) (episodes/patients-month, P<0.05).

Conclusion: Basal insulin supplementation in type 1 diabetes mellitus with either twice daily NPH insulin or glargine can result in similar glycaemic control when combined with meal time insulin aspart. However, with glargine regimen FBG, HbA1c and frequency of hypoglycaemic events are lower. These facts contribute to better patients’ satisfaction with insulin glargine versus NPH insulin in IIT in type 1 diabetics.