Switching from twice-daily premixed insulin to Lantus

Sanofi-aventis announced the results of ATLANTIC, a study to evaluate the efficacy and safety of switching 214 people with Type 2 diabetes from twice-daily premixed insulin to a combination of long-acting basal-bolus Lantus (insulin glargine) plus a rapid-acting insulin. The study, performed in a ‘real-world’ setting, also assessed treatment satisfaction, as rated by patient-reported outcomes.

“Results showed that significantly more study participants achieved an HbA1c target of <7.0 percent after switching to the combination of Lantus plus a short-acting insulin for 6 months, compared with their previous premixed insulin regimen on which they achieved poor glycemic control,” indicated Dr Fred Storm, St Antonius Hospital, Utrecht, Netherlands.

“Significant reductions were also observed in mean fasting plasma glucose and self-monitored blood glucose. As a consequence, treatment satisfaction – as reported by participants and measured by the Diabetes Treatment Satisfaction Questionnaire – improved significantly (p<0.0001) after 6 months.”

The number of people achieving an HbA1c of <7.0 percent increased from 3.3 percent at baseline to 24.9 percent after 6 months (p < 0.0001), while mean HbA1c decreased from 9.2 percent to 7.5 percent (p < 0.0001) over the same period.

Furthermore, 34 percent and 28 percent of participants reported a decrease in the incidence of nocturnal hypoglycemia (p<0.0001) and severe hypoglycemia (p<0.0001), respectively. There was no significant increase in weight gain.

“Results from the ATLANTIC study demonstrate clearly that switching from premixed insulin to a combination of Lantus plus a short-acting insulin can significantly improve HbA1c measurements – known to reduce the risk of the vascular complications of diabetes – in patients with type 2 diabetes achieving poor glycemic control on premixed insulin,” commented Dr Riccardo Perfetti, vice-president, medical affairs, global diabetes division, Sanofi-aventis.

“The notable improvement seen in treatment satisfaction was not unexpected when you consider that the combination regimen also significantly reduced the incidence of nocturnal and severe hypoglycemia – but without a concomitant increase in weight,” he noted.

Effective diabetes management always aims to lower blood glucose concentrations in order to delay or prevent the development of the microvascular complications (retinopathy, nephropathy and neuropathy) and macrovascular complications (heart attack and stroke) of diabetes.

Guidelines from the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) recommend a general target HbA1c of <7 percent, but also state that ‘clinical judgement based on the potential benefits and risks of a more intensified regimen needs to be applied for every patient.’