Data from the Asian Treat to Target Lantus Study (ATLAS) have shown that dosing of Lantus (insulin glargine) can be successfully self-adjusted by patients with type II diabetes to achieve glycemic control or administered in a physician-led programme. This was recently announced by Sanofi.
Insulin therapy is widely established as an effective and well tolerated treatment for the management of type II diabetes and patient self-management is key to optimising treatment outcomes. However, despite this, basal insulin is not as widely adopted in Asia. Initiation from diagnosis is often delayed and target glucose lowering is rarely achieved due to insufficient dose titration.
ATLAS, a randomised, multinational, 24-week study, compared the effectiveness of a patient- versus physician-led initiation (usual standard of care) of insulin glargine-based basal management. A total of 552 patients from Japan, China, Pakistan, India, the Philippines, and Russia with type II diabetes were randomly allocated to two titration arms: 275 patient-led, 277 physician-led. Both treatment groups adjusted their insulin dose using the same algorithm to achieve target fasting blood glucose levels of 110mg/dl.
Results show that patients with uncontrolled glucose levels can effectively self-adjust their insulin glargine to lower their blood glucose to near target levels, without increased occurrence of severe hypoglycemia versus physician-led titration (0.7 per cent vs. 0.7 per cent), with higher nocturnal hypoglycemia (16.4 per cent vs. 6.5 per cent, p=0.002), higher symptomatic hypoglycemia (36.0 per cent vs. 25.6 per cent, p=0.02), and few unrelated serious adverse events (3.3 per cent vs. 1.8 per cent). Levels of HbA 1c decreased in both treatment arms by an average of 1.2 per cent at week 12 and 1.3 per cent at week 24. Notably, patients self-titrated up to a significantly higher daily dose of insulin compared to the physician-led group, with a difference of 6.7 units/day (p<0.001) by week 24. In comparing the relative reduction of average glucose concentration, patient-led titration was found to be superior to physician-led titration, with a -0.15 change in mean HbA 1c from baseline at 24 weeks (p=0.04).
Patients self-titrating basal insulin showed improvements in health-related quality of life (QoL) scores comparable to levels scored by patients under physician-led titration. Diabetes Treatment Satisfaction Questionnaire status and change scores were similar between the two titration arms, with both groups showing significant improvements at 24 weeks (p<0.001). Cross-country differences in health-related QoL, as identified by the EuroQol EQ-5D patient survey, were eliminated by the end of the study.
“Subjects with type II diabetes from Asia face specific challenges in managing their condition and patient self-administration of insulin is sometimes perceived as difficult, resulting in a very limited dose adjustment to reflect the individual’s insulin needs to achieve glycemic target,” commented Satish Garg, Professor of Medicine and Pediatrics, University of Colorado, Denver, and Editor-in-Chief of Diabetes Technology & Therapeutics. “ATLAS shows that a broad range of patients, including Asians, can successfully lower blood glucose by adjusting their insulin dose themselves. These findings could be translated into future guidance in Asian countries that supports a self-management programme when patients start basal insulin therapy.”
Results from ATLAS demonstrated that dose increase of Lantus in patients with type II diabetes new to insulin therapy in Asia, Russia and Japan, whether self-titrated by patients themselves or supervised in a physician-led programme, is effective in achieving near target glycemic control on top of two oral anti-diabetic medications. Results also showed that there was no difference in the incidence of severe hypoglycemia. Also, patients initiating Lantus by self-titration may do so without compromising health-related QoL or treatment.
Pierre Chancel, Senior Vice President, Global Diabetes, Sanofi said, “As a leader in integrated diabetes care, Sanofi focuses on providing simple and convenient solutions to improve outcomes for people living with diabetes in both developing and western countries. The results of ATLAS suggest that Lantus offers adaptable patient- or physician-led once-daily administration suitable for a wide variety of patient populations.”
EP News Bureau – Mumbai