Effectiveness and safety of insulin glargine in the therapy of complicated or secondary diabetes: clinical audit

We wanted to assess the effectiveness and safety of glargine in the treatment of patients with type 2 diabetes mellitus in secondary failure and/or with severe comorbidities ("T2DM group"), and patients with secondary diabetes after corticosteroid and/or anticancer treatment ("secondary DM group"). We reviewed the records of patients on glargine from 1 August 2004 to 30 July 2005. The after-minus-before change in HbA(1c) was the main outcome measure. At baseline, the 18 "T2DM" patients had a mean (+/- SD) age of 66.7 +/- 9.5 years and a diabetes duration of 13.6 +/- 10.3 years; 52.9% were male. Their fasting plasma glucose (FPG) decreased from 228.6 +/- 76.6 to 134.6 +/- 37.5, two-hour post-prandial glycaemia (2hPPG) from 268.2 +/- 10.4 to 140.6 +/- 30.8 and HbA(1c) from 10.4 +/- 2.3 to 7.9 +/- 1.6%. Mean daily insulin dosage was 12.0 +/- 4.8 UI for glargine alone and 37.4 +/- 22.6 UI for basal-bolus scheme. The daily cost was EURO 0.75 (range EURO 0.31-1.15). The 24 "secondary DM" patients had a mean age of 67.0 +/- 11.0 years and a diabetes duration of 3.7 +/- 6.5 years; 54.2% were male and 91.7% had a metastatic cancer. Their FPG decreased from 222.3 +/- 108.6 to 121.5 +/- 28.7 mg/dl, 2hPPG from 259.4 +/- 108.6 to 133.0 +/- 35.0 mg/dl and HbA1c from 10.1 +/- 2.5 to 7.6 +/- 1.3%. Mean daily insulin dosage was 12.5 +/- 6.1 UI for glargine alone and 27.2 +/- 9.1 UI for basal-bolus scheme. Mean daily cost was EURO 0.70 (range EURO 0.31-1.38). One (4.2%) cancer patient withdrew from glargine because of nausea. Nine (37.5%) cancer patients had an increase in appetite after glargine therapy, including 3 end-of-life patients. No severe hypoglycaemia occurred. Insulin glargine was safe and effective in improving glycaemic control both in severe "T2DM" and in "secondary DM" patients.