Does insulin glargine result in higher treatment satisfaction than alternative therapies?

The authors aimed to assess patient-reported outcomes associated with initiating insulin glargine among insulin-naïve patients with type 2 diabetes mellitus. 

While type 2 diabetes may initially be managed with diet, exercise and oral antidiabetic drugs, many patients will need to move to insulin therapy to maintain disease management. Indeed, early initiation of insulin therapy may minimize the risk of diabetes-related complications. However, adverse physician and patient beliefs about the impact of insulin therapy on quality of life can often result in delayed initiation.

Insulin glargine (Lantus) is a long-acting man-made version of human insulin that replaces the insulin in the body and helps to remove glucose from the blood. Insulin glargine has previously been associated with improvements in treatment satisfaction compared to intensifying oral antidiabetic treatments or alternative insulin therapies. The Diabetes Treatment Satisfaction Questionnaire is an 8-item questionnaire used to measure therapy satisfaction in diabetes including treatment convenience, understanding of diabetes and continuation of treatment. 

This study aimed to compare treatment satisfaction associated with insulin glargine compared to active comparators (alternative drugs). 

The authors analyzed 63 clinical studies evaluating insulin glargine and an active comparator for at least 24 weeks. 1,577 patients with type 2 diabetes who had previously not undertaken insulin therapy were evaluated. 830 patients were treated with insulin glargine while 747 patients were treated with an active comparator. Active comparators included oral antidiabetic drugs, neutral protamine Hagedorn insulin (Humulin N) and premixed human insulin. The Diabetes Treatment Satisfaction Questionnaire was used to evaluate changes in treatment satisfaction at week 24 compared to prior treatment.

Analysis of both groups revealed that the increase in treatment satisfaction was significantly greater the insulin glargine group (average score: 13.5) compared to the comparator group (12.1). Lower body weight at the beginning of the study was also associated with a higher treatment satisfaction by the end of the study.

Patients were significantly more likely to perceive the treatment as satisfactory if they had a greater drop in HbA1c levels (the amount of the oxygen-carrying protein in blood that is coated in sugar) and fasting plasma glucose (blood sugar) by the end of the study.

18 patients in the insulin glargine group and 32 patients in the active comparator group had negative questionnaire scores (indicating poorer treatment satisfaction) at the end of the study. Further investigation revealed that these patients had a higher weight at the beginning of the study, gained more weight during the study and had a smaller drop in HbA1c levels.

In insulin-naïve patients with type 2 diabetes, initiation of insulin glargine is associated with greater improvements in patient-reported treatment satisfaction compared to active comparators.

Lantus was developed by Sanofi, who funded the study.