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Letter to the editor
Editor, – I would like to draw your attention to the review of insulin glargine (Aust Prescr 2004;27:50-1), particularly the statement that insulin glargine is not suitable for use in patients with type 2 diabetes.
Insulin glargine has an indication for use in type 2 patients in its approved product information. The use of insulin glargine in this patient group continues to be supported by a large body of clinical trial evidence, as well as postmarketing experience in many countries where it has been used in clinical trials or commercially available for almost five years.
The review, which referred to guidelines prepared by the National Institute for Clinical Excellence (NICE) in the UK, has omitted the important qualifying information which NICE made to its general advice on the use of insulin glargine. These guidelines in fact specify quite distinct groups of patients in which insulin glargine should be considered, which taken together account for a significant proportion of all patients with type 2 diabetes.1
In addition, the claim that 'long-term effectiveness of insulin glargine is currently unknown' is, we believe, out of date. There are several published studies involving insulin glargine lasting up to 52 weeks in duration. There is no evidence to date that the effectiveness of insulin glargine diminishes with time.
Senior Medical Advisor
Lane Cove, NSW
The Australian Prescriber comment accurately reflected the conclusion of the National Institute for Clinical Excellence (NICE) that insulin glargine 'is not recommended for routine use for people with type 2 diabetes who require insulin therapy'. The NICE recommended that insulin glargine should only be considered, in type 2 diabetes, for patients:
- who require assistance from a carer or healthcare professional to administer their insulin injections
- whose lifestyle is significantly restricted by recurrent symptomatic hypoglycaemic episodes
- who would otherwise need twice-daily basal insulin injections in combination with oral antidiabetic drugs.
- National Institute for Clinical Excellence. Guidance on the use of long-acting insulin analogues for the treatment of diabetes - insulin glargine. London: NICE; 2002. http://www.nice.org.uk/pdf/53_Insulin_analogues_full_guidance.pdf [cited 2004 Nov 8]