Insulin glargine or NPH combined with metformin in type 2 diabetes: The LANMET study
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Aims/hypothesis In type 2 diabetic patients we compared 9 months of combination therapy with insulin glargine and metformin with 9 months of NPH insulin combined with metformin. The primary focus was changes in HbA(1c); secondary focus was diurnal glucose profiles and symptomatic hypoglycaemia.Methods In this investigator-initiated open, parallel-group clinical trial involving seven centres, 110 insulin-naive type 2 diabetic patients with poor glycaemic control (HbA(1c) >or=8.0%) on oral hypoglycaemic agents (90% using sulfonylurea plus metformin) were randomised to receive bedtime insulin glargine with metformin (G+MET) or bedtime NPH with metformin (NPH+MET) for 36 weeks. The patients were taught how to self-adjust their insulin dose and use a modem to send the results of home glucose monitoring to treatment centres. The goal was to achieve a fasting plasma glucose (FPG) of 4.0 to 5.5 mmol/l in both groups.Results During the last 12 weeks, FPGs averaged 5.75+/-0.02 and 5.96+/-0.03 mmol/l (p<0.001) and insulin doses were 68+/-5 and 70+/-6 IU/day (0.69+/-0.05 and 0.66+/-0.04 IU kg(-1) day(-1), NS) in the G+MET and NPH+MET groups, respectively. At 36 weeks, mean HbA(1c) was 7.14+/-0.12 and 7.16+/-0.14%, respectively (NS). Symptomatic, but not confirmed symptomatic, hypoglycaemia was significantly lower during the first 12 weeks in the G+MET group (4.1+/-0.8 episodes/patient-year) than in the NPH+MET group (9.0+/-2.3 episodes/patient-year, p<0.05), but not significantly different thereafter. Glucose levels before dinner were higher in the NPH+MET group (10.1+/-0.3 mmol/l) than in the G+MET group (8.6+/-0.3 mmol/l, p=0.002) throughout the 36-week study. With regard to baseline characteristics such as initial glycaemia or C-peptide, there was no difference between patients who achieved good glycaemic control (HbA(1c) <7.0%) and those who did not. Differences were seen in the following: between study centres, weight gain during the run-in period and insulin therapy, and FPG during the last 12 weeks (5.7+/-0.2 vs 6.7+/-0.3 mmol/l for patients reaching vs those not reaching target, p<0.01).Conclusions/interpretation Good glycaemic control can be achieved with both G+MET and NPH+MET. Use of G+MET reduces symptomatic hypoglycaemia during the first 12 weeks and dinner time hyperglycaemia compared with NPH+MET.
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Several insulin treat-to-target trials have safely used dose titration protocols in individuals not at target A1C to reach lower than traditional FPG and PPG targets, including FPG levels of 4.5 to 5.5 mmol/L in type 2 diabetes, FPG levels of 4.0 to 5.5 mmol/L in type 2 diabetes, FPG levels of 3.9 to 5.0 mmol/L in type 1 diabetes, and protocols targeting both FPG 4.5-5.5 and 2-hour PG 5.0-7.0 in类型
“In addition, several insulin treat-to-target trials have safely used dose titration protocols in individuals not at target A1C to reach lower than”
From Targets for Glycemic Control (2018) · cites this paper as [44]
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- Authors
- Yki-Järvinen, H., Kauppinen-Mäkelin, R., Tiikkainen, M., Vähätalo, M., Virtamo, H., Nikkilä, K., Tulokas, T., Hulme, S., Hardy, K., McNulty, S., Hänninen, J., Levänen, H., Lahdenperä, S., Lehtonen, R., & Ryysy, L.
- Affiliations
- University of Helsinki (FI)
- Jorvi Hospital (FI)
- Turku City Hospital (FI)
- Lapland Central Hospital (FI)
- Whiston Hospital (GB)
- Mikkelin keskussairaala (FI)
- Sanofi (Finland) (FI)
- Kymenlaakson keskussairaala (FI)
- Corresponding author
- Yki-Järvinen, H.
- Venue
- Diabetologia
- Published
- 2006-02-03
- Volume
- 49
- Issue
- 3
- Pages
- 442-451
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W1968865647
- Cited by
- 434
- References
- 24
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 4 · 2023: 8 · 2022: 12 · 2021: 7 · 2020: 13 · 2019: 15 · 2018: 17 · 2017: 16 · 2016: 20 · 2015: 29 · 2014: 31 · 2013: 33 · 2012: 28
- FWCI
- 32.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Diabetes Association
- Eli Lilly and Company
- European Foundation for the Study of Diabetes
- Academy of Finland
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, insulin glargine, NPH insulin, metformin, basal insulin therapy, HbA1c, fasting blood glucose, insulin dose adjustment, home blood glucose monitoring, insulin-naive patients, sulfonylureas, glycemic control
- MeSH terms
- Insulin Glargine, Adult, Aged, Blood Glucose, Body Weight, Diabetes Mellitus, Type 2, Drug Therapy, Combination, Fasting, Female, Glycated Hemoglobin, Humans, Hypoglycemia, Insulin, Insulin, Isophane, Liver, Male, Metformin, Middle Aged, Insulin, Long-Acting, Lipid Metabolism
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