From insulin detemir to glargine: Effect on glycemic control and psychological wellbeing in patients with diabetes mellitus type 2 in daily practice

The success of a specific treatment is traditionally judged according to parameters such as HbA1c. However, other, patient-reported outcomes (PRO) of (insulin) therapy, become increasingly more important. The introduction of (basal) insulin-analogues could possibly improve PRO, particularly “quality of life”. Direct comparative studies between once daily insulin glargine and once to twice or twice daily insulin detemir have previously shown differences in insulin dosage, dosing frequency and weight gain. Whether this leads to a difference in quality of life in patients who are transferred from insulin detemir to insulin glargine remains to be determined. To establish the effect of insulin glargine on quality of life and patient satisfaction in patients with DM2 who are in poor metabolic control with a (human) basal insulin, a large prospective, observational study in Dutch daily practice was performed. The results of the patient population switched from NPH-insulin to insulin glargine have been published previously. In this article the results of the group of patients treated with insulin detemir before the observation period are described. The results of this observational study show that changing basal insulin therapy to insulin glargine in patients with DM2 who are in poor glycemic control with insulin detemir leads to a clinically significant improvement of glycemic control as well as emotional wellbeing, despite a small increase in weight. Whether other factors such as decreased dosing frequency play a role remains to be determined by future studies.