Background and aims: Insulin glargine 100 UmL (Gla-100) improves glycemic control in patients (pts) poorly controlled on oral antidiabetic drugs (OAD). We aimed to explore real-world titration schemes in clinical practice in Germany.

Materials and methods: Prospective, observational study in pts with type-2 diabetes attending primary care offices. Pts with an HbA1c of 7.5-10% despite being treated by 1 OAD (withwithout a non-Gla-100 basal insulin) and a physician decision to start Gla-100 therapy were included. The primary endpoint (PE) was achievement of FBG 110 mgdL or individual HbA1c target at 12 months.

Results: In the analysis (n = 2308), pts were grouped by the magnitude of insulin titration during the first month (no titration [0 U: 39.2%], 1–4 U [31.0%], 5–8 U [17.7%], or 8 U [12.1%]). At baseline, patients with 8 U were younger (64 vs. 66 years), more often female (58% vs. 50%), and had a higher mean body mass index (33 vs. 31 kgm2), fasting blood glucose (201 vs. 179 mgdl) and HbA1c (8.8% vs. 8.4%) as compared to the 0 U group (all p<0.05). At 12 months, the PE was met by a comparable proportion of patients in each group (65.0%, 68.4%, 66.7%, and 62.9% for 0 U, 1–4 U, 5-8 U and 8 U, respectively [p = n.s.]). As expected mean reductions in HbA1c and FBG were greater for 8 U than 0 U pts (-1.6% vs. -1.2% and -75.1 vs. - 51.2 mgdl, respectively, all p<0.05). Furthermore, the proportion of pts who achieved FBG 110 mgdL and their HbA1c target at 12 months was higher in the 5-8 U (27.2%; p=0.03) and 8 U groups (26.2% p=0.02). compared to the 0 U group (20.1%). Confirmed, symptomatic hypoglycemia was documented in 1.5%, 2.4%, 1.2%, and 2.2% of pts in ascending order of titration with no difference between groups.

Conclusion: The majority of patients were either not titrated at all or were titrated slowly in a real word primary care setting. More patients with a higher magnitude of titration (>+5 U) achieved an FBG 110 mgdL and their HbA1c target at 12 months.

Titration of insulin glargine in patients with type-2 diabetes– an analysis in 2308 primary care patients in Germany