Which is better- Once-daily or twice-daily insulin glargine in noncritically ill population?

The researchers found no significant differences in safety or efficacy between once-daily and twice-daily insulin glargine in the noncritically ill population. They stressed conducting a larger prospective study to confirm these results.

Diabetes, a chronic metabolic disorder affecting millions worldwide, necessitates meticulous management to prevent complications and maintain optimal blood glucose levels. Insulin is the treatment of choice for diabetes care in the hospital. Insulin Glargine, a basal insulin analog, is commonly prescribed to achieve glycemic control in individuals with type 1 and type 2 diabetes. However, the optimal dosing frequency of Insulin Glargine remains a subject of debate among healthcare providers.

Against the above background, Jennifer Clements, University of South Carolina College of Pharmacy, Greenville, SC, and colleagues aimed to evaluate the safety and efficacy of insulin glargine administered as a once-daily versus twice-daily regimen in the noncritically ill population in a pilot study.

For this purpose, they conducted a retrospective chart review from 2020 to 2021. Inclusion criteria were on a regimen of either once-daily or twice-daily insulin glargine for ≥72 hours during the specified time frame and age ≥18 years.

The primary endpoint was comparing the number of days with all blood glucose measurements within the 70–180 mg/dL range throughout 24 hours. Secondary endpoints included the number of hypoglycemic (<70 mg/dL) and hyperglycemic (>180 mg/dL) events that occurred in each study group.

The following were the key findings of the study:

• Group 1 included 101 individuals who received once-daily dosing, and Group 2 included 103 individuals who received twice-daily dosing.
• Baseline characteristics were similar between the groups except for a higher BMI at admission and a higher pre-admission A1C in group 2.
• There were no differences for the primary endpoint or hypoglycemic or hyperglycemic events.

"There were no significant differences in safety or efficacy between once-daily and twice-daily insulin glargine in the noncritically ill population," the researchers wrote. "A larger prospective study could confirm these results."

In conclusion, the retrospective analysis provides valuable insights into the dosing frequency of Insulin Glargine in noncritically ill individuals. By challenging conventional beliefs and highlighting comparable efficacy and safety outcomes between once-daily and twice-daily dosing regimens, the study empowers healthcare providers to individualize insulin therapy and optimize outcomes for patients managing diabetes.

Reference:

Deasiah Hogue, Jennifer Clements, Adrienne Wright; Retrospective Analysis of Once-Daily Versus Twice-Daily Insulin Glargine Dosing in Noncritically Ill Individuals. Diabetes Spectr 15 May 2024; 37 (2): 149–152. https://doi.org/10.2337/ds23-0029