Estudio observacional de eficacia y seguridad del cambio de insulina NPH a glargina en atención primaria. Estudio LAURA

Objective

To assess the efficacy and safety of insulin Glargine in the Primary Care setting for patients with type 2 diabetes mellitus (DM2) previously treated with NPH insulin.

Material and methods

This was an observational retrospective study, with 46 participating Primary Care physicians, who recorded the clinical information of patients treated with NPH insulin and who switched to insulin Glargine or continued on NPH for 3-9 months (inclusion design 2 Glargine:1 NPH).

Results

A total of 122 patients in the Glargine group, and 57 patients in the NPH insulin group were evaluated; the patients had a mean age of 67.0 (9.8) years, and 51.4% were males. A difference in HbA1c reduction was seen when comparing the Glargine and NPH groups: 1.07 (0.93)% vs. 0.28 (0.67)%, respectively (P < .001); fasting plasma glucose reductions were 38.4 (37.0) mg/dl vs. 15.7 (28.6) mg/dl, respectively (P < .001). Inadequate control (HbA1c ≥ 7%) at final visit was noted in 61.3% vs. 76.8% of patients (P = .028), respectively. Total hypoglycemic and nocturnal hypoglycemic episodes within one month prior to final visit were 6.6% vs. 43.9%, and 2.5% vs. 21.1%, respectively (P < .0001). The variables associated with better glycemic control were lower baseline HbA1c and fasting plasma glucose values, and the switch to Glargine. The main reason for change was the advantage of one injection a day.

Conclusion

Patients with DM2 who are treated with NPH insulin in Primary Care and switch to Glargine show better glycemic control and experience fewer total and nocturnal hypoglycemic episodes.