The FINANCIAL — Association’s (ADA) 68th Annual Scientific Sessions reinforce the importance of promptly initiating insulin treatment when patients with type 2 diabetes are unable to achieve recommended glycemic targets with diet, exercise and oral diabetes medications alone.
In the TULIP (Testing the Usefulness of LANTUS when Initiated Promptly in patients with type 2 diabetes) clinical study, 66 percent of patients who began treatment with the long-acting, basal insulin LANTUS (insulin glargine [rDNA origin] injection) achieved A1C <7%, the ADA’s recommended target for glycemic control, while only 38 percent of patients from the lifestyle management arm were able to achieve the recommended target levels.
In an effort to help guide treatment decisions, the ADA and European Association for the Study of
Diabetes (EASD) developed a Consensus Algorithm for Type 2 Diabetes that calls for healthcare
providers and diabetes patients to initiate insulin therapy when A1C <7% is not achieved with oral
medications and lifestyle management alone.i However, physicians typically wait for A1C to approach 9% before adding insulin.ii In general, every percentage point drop in A1C blood test results (e.g., from 8.0% to 7.0%) reduces the risk of microvascular complications (eye, kidney, and nerve diseases) by 40%iii.
The most common side effect of any insulin, including LANTUS, is hypoglycemia, which may be serious. In the LANTUS arm of the TULIP trial, there were 4.2±6.6 (p<0.0001) cases of symptomatic, 0.7±2.1 (p=0.0011) cases of nocturnal and 0.04±0.35 (p=0.147) cases of severe hypoglycemia events reported per patient year. However, no patients dropped out of the trial due to hypoglycaemia.
“When glycemic targets are not achieved with diet, exercise and oral medications given at maximum
tolerated dose, patients with type 2 diabetes have reached a critical moment in the lifecycle of their
condition,” said Andre Grimaldi, MD, Professor Diabetes Department Head, Pitié-Salpêtrière Hospital, Paris, France. “The results observed in TULIP demonstrate the value of following the ADA/EASD treatment recommendations by initiating basal insulin therapy in a timely manner.”
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