Comparison of fasting blood glucose levels in patients with Type 2 diabetes after 12 weeks of treatment with a new basal insulin analog or with insulin glargine.

Patients in this study will continue to use their stable prestudy dose of metformin and/or a sulfonylurea. Prestudy therapy also includes once daily insulin glargine or NPH insulin. The 12-week active treatment phase will be followed by a 4-week follow-up period, during which patients will return to the basal insulin recommended by the investigator.

• Drug: LY2605541
  subcutaneous injection of LY2605541 every morning with dose titration based on blood glucose measures for 12 weeks
• Drug: insulin glargine
  subcutaneous injection of insulin glargine every morning with dose titration based on blood glucose measures for 12 weeks

• LY2605541 Dosing Algorithm 1: Experimental
  Intervention: Drug: LY2605541
• LY2605541 Dosing Algorithm 2: Experimental
  Intervention: Drug: LY2605541
• Insulin glargine: Active Comparator
  Intervention: Drug: insulin glargine

Inclusion Criteria:

• Type 2 diabetes mellitus (T2DM) for at least 1 year
• At least 18 years of age
• Using metformin and/or sulfonylurea(s) with once daily glargine or NPH for at least 3 months prior to the study. Prestudy dose requirements: insulin dose maximum 1.0 U/kg/day. Oral antihyperglycemic medications (OAMs): Metformin dose at least 1500 mg/day and/or sulfonylurea dose at least half the maximum daily dose specified in the local package insert. OAM doses stable for 6 weeks prior to the study.
• HbA1c less than or equal to 10.5% before randomization
• BMI 19 to 45 kg/m2
• Capable and willing to prepare and inject insulin with a syringe while continuing to use the prestudy OAMs, monitor own blood glucose; complete the study diary; be receptive to diabetes education; comply with study visits and receive telephone calls between visits
• Women of childbearing potential must test negative for pregnancy before receiving treatment and agree to use reliable birth control until completing the follow-up visit

Exclusion Criteria:

• Long-term use of short- or rapid-acting or premixed insulin within the 6 months before the study. Short-term insulin therapy or occasional use are permitted
• Use of any glucose-lowering medications not allowed by the inclusion criteria in the 3 months before entry into the study
• Use of prescription or over-the-counter medications to promote weight loss within 3 months before entry into the study
• Current participation in a weight loss program, or plans to do so during the study
• Treatment with any antibody-based therapy within 6 months prior to the study
• Use of chronic (>14 consecutive days) systemic glucocorticoid therapy currently or within 4 weeks prior to the study
• More than 1 episode of severe hypoglycemia within 6 months prior to the study, or currently diagnosed with hypoglycemia unawareness
• 2 or more emergency room visits or hospitalizations due to poor glucose control in the 6 months preceding the study
• Liver disease
• History of renal transplantation, current renal dialysis, or creatinine >2.0 mg/dL (177 μmol/L)
• Cardiac disease with a marked impact on physical functioning
• Clinically significant ECG abnormalities at screening
• Malignancy other than basal cell or squamous cell skin cancer
• Fasting triglycerides >500 mg/dL
• Known diabetic autonomic neuropathy
• Known hypersensitivity or allergy to study insulin or its excipients
• Blood transfusion or severe blood loss within 3 months prior to entry into the study or known hemoglobinopathy, hemolytic anemia, or sickle cell anemia, or any other traits of hemoglobin abnormalities known to interfere with the HbA1c methodology
• Irregular sleep/wake cycle
• Women who are breastfeeding