Basal insulin or premix analogue therapy in type 2 diabetes patients

Philip Raskin, Priscilla A. Hollander, Andrew Lewin, Robert A. Gabbay, Bruce Bode, Alan J. Garber

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Background: We sought to compare the safety and efficacy of biphasic insulin aspart 30 (BIAsp 30) given twice daily with once-daily insulin glargine in patients with type 2 diabetes beginning insulin therapy and who did not use thiazolidinediones, which are contraindicated with insulin in the European Union, in a subpopulation (N = 157) of the INITIATE study. Methods: At baseline, HbA1c was ≥ 8.0% on ≥ 1000 mg/day metformin alone or in combination with other oral antidiabetic drugs (OADs; e.g. sulphonylurea or alpha-glucosidase inhibitors). Metformin was adjusted up to 2550 mg/day and other OADs were discontinued. Starting insulin doses were subsequently adjusted weekly for 26 weeks by algorithm-directed titration. Results: The proportion of patients achieving a HbA1c below 7.0% at 28 weeks was greater with BIAsp 30 than with insulin glargine (65% vs 41%, P = 0.003). The mean reduction in HbA1c was greater for BIAsp 30 than for insulin glargine: - 2.89 ± 1.6% vs - 2.46 ± 1.6%, respectively (P = 0.035). Postprandial glucose increments were lower for the BIAsp 30 group after breakfast (P = 0.003) and dinner (P = 0.033); post-lunch values were not significantly different. No major hypoglycemic episodes were recorded. Nocturnal hypoglycemia was reported by 25% of subjects in the BIAsp 30 group and by 10% in the insulin glargine group (P = 0.021). Weight gain was 5.6 ± 4.6 and 3.0 ± 4.3 kg (P = 0.0004) for BIAsp 30 and insulin glargine, respectively. Conclusions: BIAsp 30, given twice daily in combination with metformin, was more effective than insulin glargine, given once daily in combination with metformin, at controlling blood glucose in insulin-naïve patients with type 2 diabetes, but was associated with increased weight gain and minor hypoglycemic events.

Original languageEnglish (US)
Pages (from-to)56-62
Number of pages7
JournalEuropean Journal of Internal Medicine
Volume18
Issue number1
DOIs
StatePublished - Jan 2007

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Type 2 Diabetes Mellitus
Insulin
Metformin
Hypoglycemic Agents
Therapeutics
Weight Gain
Thiazolidinediones
Lunch
Breakfast
European Union
insulin aspart, insulin aspart protamine drug combination 30:70
Hypoglycemia
Meals
Blood Glucose
Insulin Glargine
Safety
Glucose

Keywords

  • Clinical protocols
  • Hypoglycemic agents
  • Insulin analogs
  • Type 2 diabetes mellitus

ASJC Scopus subject areas

  • Medicine(all)
  • Internal Medicine

Cite this

Basal insulin or premix analogue therapy in type 2 diabetes patients. / Raskin, Philip; Hollander, Priscilla A.; Lewin, Andrew; Gabbay, Robert A.; Bode, Bruce; Garber, Alan J.

In: European Journal of Internal Medicine, Vol. 18, No. 1, 01.2007, p. 56-62.

Research output: Contribution to journalArticle

Raskin, Philip ; Hollander, Priscilla A. ; Lewin, Andrew ; Gabbay, Robert A. ; Bode, Bruce ; Garber, Alan J. / Basal insulin or premix analogue therapy in type 2 diabetes patients. In: European Journal of Internal Medicine. 2007 ; Vol. 18, No. 1. pp. 56-62.
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abstract = "Background: We sought to compare the safety and efficacy of biphasic insulin aspart 30 (BIAsp 30) given twice daily with once-daily insulin glargine in patients with type 2 diabetes beginning insulin therapy and who did not use thiazolidinediones, which are contraindicated with insulin in the European Union, in a subpopulation (N = 157) of the INITIATE study. Methods: At baseline, HbA1c was ≥ 8.0{\%} on ≥ 1000 mg/day metformin alone or in combination with other oral antidiabetic drugs (OADs; e.g. sulphonylurea or alpha-glucosidase inhibitors). Metformin was adjusted up to 2550 mg/day and other OADs were discontinued. Starting insulin doses were subsequently adjusted weekly for 26 weeks by algorithm-directed titration. Results: The proportion of patients achieving a HbA1c below 7.0{\%} at 28 weeks was greater with BIAsp 30 than with insulin glargine (65{\%} vs 41{\%}, P = 0.003). The mean reduction in HbA1c was greater for BIAsp 30 than for insulin glargine: - 2.89 ± 1.6{\%} vs - 2.46 ± 1.6{\%}, respectively (P = 0.035). Postprandial glucose increments were lower for the BIAsp 30 group after breakfast (P = 0.003) and dinner (P = 0.033); post-lunch values were not significantly different. No major hypoglycemic episodes were recorded. Nocturnal hypoglycemia was reported by 25{\%} of subjects in the BIAsp 30 group and by 10{\%} in the insulin glargine group (P = 0.021). Weight gain was 5.6 ± 4.6 and 3.0 ± 4.3 kg (P = 0.0004) for BIAsp 30 and insulin glargine, respectively. Conclusions: BIAsp 30, given twice daily in combination with metformin, was more effective than insulin glargine, given once daily in combination with metformin, at controlling blood glucose in insulin-na{\"i}ve patients with type 2 diabetes, but was associated with increased weight gain and minor hypoglycemic events.",
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AU - Raskin, Philip

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AU - Lewin, Andrew

AU - Gabbay, Robert A.

AU - Bode, Bruce

AU - Garber, Alan J.

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N2 - Background: We sought to compare the safety and efficacy of biphasic insulin aspart 30 (BIAsp 30) given twice daily with once-daily insulin glargine in patients with type 2 diabetes beginning insulin therapy and who did not use thiazolidinediones, which are contraindicated with insulin in the European Union, in a subpopulation (N = 157) of the INITIATE study. Methods: At baseline, HbA1c was ≥ 8.0% on ≥ 1000 mg/day metformin alone or in combination with other oral antidiabetic drugs (OADs; e.g. sulphonylurea or alpha-glucosidase inhibitors). Metformin was adjusted up to 2550 mg/day and other OADs were discontinued. Starting insulin doses were subsequently adjusted weekly for 26 weeks by algorithm-directed titration. Results: The proportion of patients achieving a HbA1c below 7.0% at 28 weeks was greater with BIAsp 30 than with insulin glargine (65% vs 41%, P = 0.003). The mean reduction in HbA1c was greater for BIAsp 30 than for insulin glargine: - 2.89 ± 1.6% vs - 2.46 ± 1.6%, respectively (P = 0.035). Postprandial glucose increments were lower for the BIAsp 30 group after breakfast (P = 0.003) and dinner (P = 0.033); post-lunch values were not significantly different. No major hypoglycemic episodes were recorded. Nocturnal hypoglycemia was reported by 25% of subjects in the BIAsp 30 group and by 10% in the insulin glargine group (P = 0.021). Weight gain was 5.6 ± 4.6 and 3.0 ± 4.3 kg (P = 0.0004) for BIAsp 30 and insulin glargine, respectively. Conclusions: BIAsp 30, given twice daily in combination with metformin, was more effective than insulin glargine, given once daily in combination with metformin, at controlling blood glucose in insulin-naïve patients with type 2 diabetes, but was associated with increased weight gain and minor hypoglycemic events.

AB - Background: We sought to compare the safety and efficacy of biphasic insulin aspart 30 (BIAsp 30) given twice daily with once-daily insulin glargine in patients with type 2 diabetes beginning insulin therapy and who did not use thiazolidinediones, which are contraindicated with insulin in the European Union, in a subpopulation (N = 157) of the INITIATE study. Methods: At baseline, HbA1c was ≥ 8.0% on ≥ 1000 mg/day metformin alone or in combination with other oral antidiabetic drugs (OADs; e.g. sulphonylurea or alpha-glucosidase inhibitors). Metformin was adjusted up to 2550 mg/day and other OADs were discontinued. Starting insulin doses were subsequently adjusted weekly for 26 weeks by algorithm-directed titration. Results: The proportion of patients achieving a HbA1c below 7.0% at 28 weeks was greater with BIAsp 30 than with insulin glargine (65% vs 41%, P = 0.003). The mean reduction in HbA1c was greater for BIAsp 30 than for insulin glargine: - 2.89 ± 1.6% vs - 2.46 ± 1.6%, respectively (P = 0.035). Postprandial glucose increments were lower for the BIAsp 30 group after breakfast (P = 0.003) and dinner (P = 0.033); post-lunch values were not significantly different. No major hypoglycemic episodes were recorded. Nocturnal hypoglycemia was reported by 25% of subjects in the BIAsp 30 group and by 10% in the insulin glargine group (P = 0.021). Weight gain was 5.6 ± 4.6 and 3.0 ± 4.3 kg (P = 0.0004) for BIAsp 30 and insulin glargine, respectively. Conclusions: BIAsp 30, given twice daily in combination with metformin, was more effective than insulin glargine, given once daily in combination with metformin, at controlling blood glucose in insulin-naïve patients with type 2 diabetes, but was associated with increased weight gain and minor hypoglycemic events.

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