Add-on therapy with insulin glargine appeared to have superior results, despite similar glycemic control.
A recently published study compared oral rosiglitazone (Avandia) and a single daily injection of insulin glargine (Lantus) as add-on therapy for 217 patients with type 2 diabetes whose glycemic control was inadequate with metformin and sulfonylurea (Journal Watch Mar 17 2006). The study, funded by the maker of insulin glargine, found similar glycemic control in the insulin and rosiglitazone groups at 24 weeks. An additional outcome of interest, quality of life, is addressed in a new report from that study.
Both groups improved in most quality-of-life indicators at 24 weeks, as assessed by standardized questionnaires. However, improvements in a total symptom score and a total symptom distress score were significantly greater in the insulin group than in the rosiglitazone group. Several individual symptoms (mood, vision, and fatigue) also showed significantly greater improvement with insulin than with rosiglitazone. There were no significant differences between groups for other symptoms (e.g., cognitive, neuropathic, cardiovascular).
Comment: In this study, add-on therapy with insulin glargine appeared to improve health-related quality of life to a greater extent than rosiglitazone, despite similar glycemic control in the two groups. These results should be reassuring to patients who are anxious about starting insulin glargine. However, clinicians should ultimately individualize add-on therapy by considering patient preferences and the potential side effects and costs of the proposed treatments.
— Allan S. Brett, MD
Published in Journal Watch General Medicine May 3, 2007
Vinik AI and Zhang Q. Adding insulin glargine versus rosiglitazone: Health-related quality-of-life impact in type 2 diabetes. Diabetes Care 2007 Apr; 30:795-800.