Diabetes Treatment Review
Reducing the risk of hypoglycemia with basal insulin analogues
Martin Gilmour of the Diabetic Hypoglycemia Editorial Team
Diabetic Hypoglycemia June 2008, Volume 1, Issue 1: page 15-16
Adding insulin to oral therapy is standard practice when treating patients with type 2 diabetes, but this increases the risk of hypoglycemia. Lower frequencies of severe hypoglycemia with basal insulin analogs have been reported both in clinical trials and in clinical practice. This review covers three recent publications that highlight the use of basal insulin analogs in type 2 diabetes, and their benefits in reducing hypoglycemia.
A pooled analysis of three open-label trials indicates that in patients with type 2 diabetes the risk of severe hypoglycemia associated with insulin detemir is lower, compared with isophane or neutral protamine Hagedorn (NPH) insulin. A meta-analysis of trials comparing basal insulin glargine with NPH insulin found a reduced incidence of severe hypoglycemia with insulin glargine. The article also reviews the published results of the 4-T Study – the first large-scale comparison of different insulin analog regimens. The authors concluded that more patients with type 2 diabetes achieve target glucose levels if they receive prandial insulin analogs or biphasic insulin analogs than if they receive basal insulin analogs alone, but that the incidence of hypoglycemic events and weight gain are increased with biphasic or prandial insulin compared with basal insulin.
The review concludes that these results emphasize the need to individualize insulin therapy in patients with type 2 diabetes when choosing the most appropriate insulin regimen, and points out that older patients may be more vulnerable both to hypoglycemia and fear of hypoglycemia; therefore, elderly patients may be a priority in switching from conventional insulin regimens to insulin analog-containing regimens.
Keywords: hypoglycemia, basal insulin analogs, insulin therapy