Intensification of Diabetes Treatment with Long-Acting Insulin Shows no Benefit over Other Diabetes Treatment

Background: Control of diabetes is challenging, and frequent treatment changes are needed. Objective: To study the effect of the recommendation to start insulin glargine or insulin determir (long-acting insulin treatment, LAI) at discharge from hospital, on glucose control in the community setting. Methods: Included were type II diabetes patients who were referred to and received a consultation from the hospital diabetes clinic during their hosptialization, as part of a routine consultation for diabetes management. During the visit, all patients were recommended long-acting insulin-based treatment, as inpatient treatment and at discharge. Follow-up was done by the primary physician in the community or by a community-based diabetes clinic. Glycosylated hemoglobin, glucose levels and other laboratory tests were obtained from the community health records before hospitalization and 6-12 months later. Medical treatment was ascertained by reviewing the actual usage of prescriptions. Results: Eighty patients (58% males, mean age 64.1 +/- 12.7 years) were included in the analysis. HbA1c levels were 10.1 +/- 2.4% before admission, but improved significantly at follow-up (8.6 +/- 2.2%, P < 0.001). Seventy-one percent of the patients were taking the LAI treatment and the rest were using non-LAI medications. Changes in diabetes control were similar between the LAI and non-LAI groups (HbA1c was reduced by 1.5 +/- 3.2% and 1.9 +/- 3.1% respectively). The rate of repeated admissions was also similar, averaging at 1.3 admissions for both groups, the minority of which were related to glucose control. Conclusions: Insulin glargine or determir-based treatment does not show any superiority over other anti-diabetes treatment. It is our opinion that this treatment should be used as tailored therapy and should not be recommended routinely to all patients. IMAJ 2011; 13; 537-541