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Glycemic Control With Insulin Glargine as Part of an Ethnically Diverse, Community-Based Diabetes Management Program

Philis-Tsimikas, Athena MD*; Zhang, Quanwu PhD; Walker, Chris MPH

doi: 10.1097/01.mjt.0000245222.43783.0c
Original Article
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Objective: To evaluate the contribution of long-acting basal insulin therapy (insulin glargine) to glycemic control in a predominantly Hispanic population participating in a community-based diabetes management program, Project Dulce.

Research Design and Methods: This retrospective analysis included 3122 adult patients with diabetes from 17 community clinics in San Diego County, California who participated in Project Dulce between July 2000 and March 2003. A subset of 180 patients received insulin glargine because of ongoing, inadequate glycemic control (ie, elevated HbA1c). Glycemic control was evaluated by mean adjusted HbA1c during follow-up clinical visits using hierarchical linear modeling, with values determined separately before and after initiation of insulin glargine.

Results: At baseline, the mean number of individuals with hypoglycemia, presence of diabetic complications, and duration of diabetes were greater in the glargine group that in the reference group. HbA1c at baseline was 8.79 and 9.44 (P = 0.019) in the reference and glargine groups, respectively. Mean adjusted HbA1c in the glargine group was 8.80 at baseline, 7.89 before initiation of insulin glargine (P < 0.001 vs baseline), and 7.34 after adding insulin glargine (P < 0.001 vs pre-glargine). In the reference group, mean adjusted HbA1c decreased from 8.81 at baseline to 7.40 during follow-up (P < 0.001 vs baseline).

Conclusions: A comprehensive program of diabetes care in Project Dulce improved HbA1c significantly in a predominantly Hispanic population. Adding long-acting basal insulin therapy with insulin glargine produced significant incremental improvement in HbA1c.

The Whittier Institute for Diabetes, Scripps Health, La Jolla, California.

Financial and in-kind support for the Project Dulce program has been provided by The California Endowment and contracted service agreements with various health plan providers and the County of San Diego. This study was supported in part by sanofi- aventis Pharmaceuticals.

*Address for correspondence: 5676 Berkshire Valley Road Oak Ridge, New Jersey 07438. E-mail: phillis-tsimikas.athena@scrippshealth.org

© 2006 Lippincott Williams & Wilkins, Inc.