Comparison Study of Insulin Glargine and NPH Insulin

Basal Insulin Therapy in Patients With Insulin Resistance: A 6 Month Comparison of Insulin Glargine and NPH Insulin

This study will compare the safety, effectiveness, and cost of two different types of long-acting insulin.

In this study the investigators will be comparing two long-acting insulins, insulin glargine and NPH insulin. The trial will be evaluating differences in effectiveness, safety and cost between the two agents when used in patients on more than 80 units or 1unit/kg long-acting insulin. The investigators hypothesis is that patients switched from lantus to NPH will have improved blood glucose control.

Inclusion Criteria:

• Adult patients at 22 Providence Medical Group primary care clinics
• Diagnosis of type 2 diabetes mellitus
• Currently using greater than 80 units/day of insulin glargine or greater than 1 unit/kg/day of insulin glargine
• Current A1C > 8.5% (within 3 months of randomization)

Exclusion Criteria:

• Diagnosis of type 1 diabetes mellitus
• Age > 85 years
• Self-reported history of severe hypoglycemia or hypoglycemia unawareness
• Hospice/limited life expectancy
• Current enrollment in Providence Medical Group Medication Assistance Program
• Current use of a GLP1 agonist (i.e., liraglutide, exenatide, exenatide extended-release)
• End stage renal disease (i.e., dialysis or estimated glomerular filtration rate <15 ml/min/1.73m2)
• Cirrhosis
• Unstable coronary artery disease or chronic heart failure (i.e. an exacerbation or hospitalization within 6 months pre-randomization)
• Psychiatric condition that prevents adequate follow-up (i.e., > 3 missed follow-up visits within a 3 month period or persistent non-adherence to dosing or monitoring recommendations)
• Active alcohol or drug abuse
• Inability to provide informed consent