(HealthDay is the new name for HealthScoutNews.)
THURSDAY, June 19, 2003 (HealthDayNews) -- Taking a new long-acting insulin drug in the morning to supplement oral diabetes medication produces better blood sugar control than taking it at night, a new study finds.
German researchers assigned 695 patients with type 2 diabetes to one of three groups: a morning injection of glargine (brand name Lantus) with their oral pill, bedtime glargine with their oral pill, or a bedtime injection of another type of insulin, neutral protamine hagedorn (NPH) insulin with their oral pill. Doctors often add on insulin for those with type 2 diabetes when the oral medication does not provide enough blood sugar control.
After 24 weeks, blood sugar control improved in all three groups, but it improved the most in those who injected the glargine in the morning. The researchers can't explain why the morning injection worked best.
The results appear in the June 17 issue of the Annals of Internal Medicine. The study was funded by a grant from Aventis Pharmaceuticals, which makes Lantus.
Most long-acting insulins have a "peak," or the time at which they work most strongly to lower blood sugar. At this peak time, blood sugar can fall dangerously low unless enough food is at hand.
But glargine, the researchers say, is different because it does not peak but rather works to lower blood sugar slowly but surely over 24 hours. NPH insulin peaks about four to six hours after injection, the researchers say.
About 17 million people in the United States have diabetes, according to the American Diabetes Association, with nearly 6 million not aware they have the disease. The vast majority of these people have type 2 diabetes, where the body fails to make enough insulin and properly use it. Insulin is a hormone needed to convert sugar, starches and other food into energy. In type 1 diabetes, the pancreas stops making insulin altogether.
The new study makes sense to Dr. Daniel Lee, an attending faculty member at the Santa Monica-UCLA family practice residency program and assistant clinical professor of family medicine at the UCLA David Geffen School of Medicine in Los Angeles. "The nice thing is, they all improved," he says of all three groups, noting that blood sugar control is the crucial goal.
Lee notes that a physician treating a patient with type 2 diabetes commonly has many options. "Most first get prescribed a one- or two- or three-drug oral regimen before going on insulin," he explains. If that's not enough, an injection of insulin may be added to the oral medicine.
"This regimen [the morning glargine] is a player," Lee says. While it is commonly prescribed by doctors, the study is believed to be the first to examine a pre-breakfast injection of glargine.
Lee notes "it wasn't a huge improvement'' in the morning glargine group, but every little bit of control over blood sugar can help.
Based on the study results, he might now recommend morning glargine in his patients on this regimen, he says. Still, he adds, everyone reacts differently and "some people might be better to do the glargine at night."
More information
For a discussion of oral diabetes medications, try the American Diabetes Association or the Joslin Diabetes Center.
