Timing of Insulin Glargine 300 U/ML: Does It Really Matter in Terms of Efficacy and Safety at Insulin Initiation?

Background: The timing of insulin administration, particularly for long-acting insulins like insulin glargine 300 U/mL (Gla-300), plays a critical role in diabetes management. The choice between daytime and nighttime administration of Gla-300 is a nuanced decision that should be tailored to each patient's unique circumstances. This study aims to compare the efficacy and safety profile of insulin initiation with Gla-300 when administered during the day versus at night in adult type 2 diabetes mellitus (T2DM) patients.

Methods: A retrospective observational study included records of adult T2DM patients initiated on Gla-300 with follow-up data of three months. Cases with complete medical records, including hemoglobin A1C (HbA1C) levels, fasting plasma glucose (FPG), post-prandial plasma glucose (PPPG), and incidence of hypoglycemic events, were included. Data pertaining to glycaemic control and safety, were extracted and categorized into two groups based on the timing of Gla-300 administration. Records were evaluated over three months and results were statistically analysed.  Results: A total of 169 patients, matched for baseline characteristics, showed a significant reduction in glycaemic indices from initiation to the third month. However, intergroup difference was non-significant suggesting that the timing of administration (morning vs. night) does not significantly impact the effectiveness of Gla-300 in lowering the glycemic indices. Incidences of overall hypoglycemic events were numerically lesser in those with morning dosing of Gla-300 at 13.09% as compared to those with night dosing of Gla-300 at 21.17%. Nocturnal hypoglycaemia was numerically lesser in those with morning dosing of Gla-300 at 3.57% as compared to those with night dosing of Gla-300 at 7.05% observed. However, these intergroup differences were insignificant (p> 0.05).

Conclusion: Timing of Gla-300 initiation, morning compared to night dosing, does not significantly impact the effectiveness in lowering the glycemic indices. Incidences of overall and nocturnal hypoglycemic events were numerically lower with morning dosing of Gla-300 compared to night dosing of Gla-300, though it was not statistically significant. An individualized approach to timing and selection of insulin therapy is essential for optimizing glycemic control and minimizing hypoglycemia risk.