Timing of Insulin Glargine May be Important: Study

By Reuters Staff

NEW YORK (Reuters Health) - In type 2 diabetes patients, the effects of insulin glargine differ depending on time of administration, researchers from Italy have observed. But this has more to do with circadian changes in insulin sensitivity (lower in the night-early morning vs afternoon hours) than insulin glargine, they say.

The study online now in Diabetes Care is the first to directly compare pharmacokinetics and pharmacodynamics of basal insulin glargine given at different times of day in insulin-treated T2DM patients, say Dr. Francesca Porcellati and colleagues from University of Perugia Medical School.

"The question is relevant not only in light of the potential clinical translation of the findings, but also considering the great emphasis recently given to the concept of flexibility of dosing time, which has been advocated mainly for the second-generation long-acting insulin analogs," they point out.

In a crossover study, they had 10 patients undergo two 24-hour euglycemic glucose clamp studies, after morning (10 AM) or evening (10 PM) subcutaneous injection of glargine (0.4 units/kg).

Overall 24-hour insulin activity was not different whether insulin glargine was given in the morning or in the evening, the authors report.

"However, relevant differences emerged when considering time action profiles and distribution of metabolic effects in the first 12-h period compared with the second 12-h period," they say.

Giving glargine in the morning exerted greater insulin activity in the first 12-hours, in contrast to evening dosing, which exhibited higher potency in the second 12 hours.

In addition, with evening administration, the suppression of nocturnal endogenous glucose production, lipolysis and glucagon concentration were "more consistent." Therefore, "targeting fasting euglycemia appears more convenient with evening glargine dosing compared with morning glargine dosing. Conversely, morning dosing may be preferable whenever greater protection against the risk for nocturnal hypoglycemia is needed," the investigators conclude.

The study did not have commercial funding. The authors did not respond to request for comment by press time.

SOURCE: https://bit.ly/1AOxX9v

Diabetes Care 2014.

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