Treatment Trial Evaluating Long Acting Insulin in Type 1 Diabetes
Treatment Trial Evaluating Long Acting Insulin in Type 1 Diabetes
Patients with type 1 diabetes trained in multiple daily insulin injection were treated with
 two diffferent kinds of long acting insulin preparations. The two insulin preparations were
 glargine and ultralente insulin. Patients were randomized to receive one of the two insulin
 preparations for the first 4 months followed by the second preparation for a further four
 months. Short acting insulin used was the same during both periods. We found that glargine
 insulin was better than ultralente insulin in our study.
Multiple daily insulin injection (MDI) programs are commonly accompanied by considerable
 glycemic variation and hypoglycemia. In order to determine whether use of insulin glargine as
 a basal insulin would result in comparable HbA1c with less glycemic variation and
 hypoglycemia than ultralente insulin, 22 individuals with type 1 diabetes, experienced with
 MDI, and a HbA1c of <7.8 % were randomized, to receive either glargine or ultralente as the
 basal insulin for 4-months. Aspart insulin was used as the prandial. Physicians providing
 insulin dose adjustment advice were masked to the type of basal insulin. Treatment with
 glargine resulted in lower mean HbA1c, less nocturnal variability , and less hypoglycemia
 primarily due to less daytime hypoglycemia (p=0.002). On the other hand, serious hypoglycemia
 and average glucose concentration measured with continuous glucose monitoring system (CGMS)
 did not differ. We conclude that, while use of either ultralente or glargine as a basal
 insulin can result in excellent glycemic control, treatment with glargine is associated with
 slightly but significantly lower HbA1C, with less nocturnal glycemic variability and less
 hypoglycemia.
Type 1 diabetes, HbA1c < 7.8%, who have had prior instruction in a complex insulin program,
 and presently using a MDI insulin program with basal insulin preparations of Glargine or
 Ultralente and Humalog as the short acting insulin, should be free of hepatorenal
 abnormalities and hypoglycemia unawareness; non-pregnant, and should be able to perform
 frequent self monitoring of blood glucose (SMBG) and accept the use of continuous glucose
 monitoring system (CGMS). They should also possess the skill and understanding of insulin
 dose adjustments and supplementation.