Improved glycemic control without an increase in severe hypoglycemic episodes in intensively treated patients with type I diabetes receiving morning, evening, or split dose insulin glargine

Objective: To see if insulin glargine improves glycemic control in a clinical setting. Research design and methods: A questionnaire and electronic database were used to assess glycemic parameters for 292 type 1 diabetic subjects taking greater than or equal to4 injections per day and receiving glargine as their only long-acting basal insulin for at least 6 months. Sixty-three subjects were taking glargine in the morning, 125 were taking glargine in the evening, and 104 were splitting the glargine, dose between the morning and evening. Results: The mean (+/-S.D.) age and duration of diabetes were 32 +/- 10 years and 15.9 +/- 10.3 years, respectively. The mean (+/-S.E.M.) durations of treatment with glargine were 13.1 +/- 0.6 months, 12.2 +/- 0.4 months, and 14.3 +/- 0.5 months for the morning, evening, and split treatment groups, respectively (P < 0.01). The A1C values improved significantly from baseline for the evening and the split dosage groups or when all groups were combined. The mean basal insulin dose was significantly reduced at the end of the study in all the three groups from baseline with no change in the short-acting insulin dose. The number of severe hypoglycemic episodes decreased from 379 in the year prior to glargine treatment to 167 in the post-glargine year. The weight gain was significantly higher in the group that took the split glargine dose (P < 0.01). Conclusions: Similar or improved glycemic control was achieved by administering glargine in the moming, evening, or using a split dose without any further increase in severe hypoglycemic episodes. Splitting the glargine dose did not offer any advantages in glycemic control parameters. (C) 2004 Elsevier Ireland Ltd. All rights reserved.