Individualizing treatment of type 2 diabetes by targeting postprandial or fasting hyperglycaemia: Response to a basal vs a premixed insulin regimen by HbA1c quartiles and ethnicity

2015 ◽  
Vol 41 (3) ◽  
pp. 216-222 ◽  
Author(s):  
A.J. Scheen ◽  
H. Schmitt ◽  
H.H. Jiang ◽  
T. Ivanyi
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Regimen ◽  
Premixed Insulin ◽  
Fasting Hyperglycaemia

scholarly journals Hypoglycemia in type 2 diabetes patients treated with insulin: the advantages of continuous glucose monitoring

2014 ◽  
Vol 17 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Vadim Valer'evich Klimontov ◽  
Alexander Ivanovich Tsiberkin ◽  
Olga Nikolaevna Fazullina ◽  
Marina Alekseevna Prudnikova ◽  
Nadezhda Viktorovna Tyan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Insulin Regimen ◽  
Premixed Insulin ◽  
Dipeptidyl Peptidase 4 ◽  
Retrospective Data Analysis ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Bolus Insulin

Aims.  To determine the incidence and risk factors for hypoglycemia in elderly insulin-treated type 2 diabetes mellitus (T2DM) patients by means of continuous glucose monitoring (CGM). Materials and Methods.  We observed seventy-six hospitalized patients with T2DM, aged 65 to 79 years. Treatment with basal insulin (n=36), premixed insulin (n=12) or basal-bolus insulin regimen (n=28) was followed by metformin (n=44), glimepiride (n=14) and dipeptidyl peptidase-4 inhibitors (n=14). 2-days CGM with retrospective data analysis was performed in all patients. During CGM, three fasting and three 2-h postprandial finger-prick glucose values were obtained daily with portable glucose meter. Results.  Hypoglycemia (identified as blood glucose

scholarly journals THERAPY OF ENDOCRINE DISEASE: Insulin initiation in patients with type 2 diabetes mellitus: treatment guidelines, clinical evidence and patterns of use of basal vs premixed insulin analogues

2012 ◽  
Vol 166 (2) ◽  
pp. 159-170 ◽  
Author(s):  
Allan Vaag ◽  
Sørens Lund
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Practice ◽  
Well Being ◽  
Insulin Analogues ◽  
Insulin Regimen ◽  
Complex Treatment ◽  
Insulin Initiation ◽  
Premixed Insulin ◽  
Treatment Regimens

This review addresses the apparent disconnect between international guideline recommendations, real-life clinical practice and the results of clinical trials, with regard to the initiation of insulin using basal (long-acting) or premixed insulin analogues in patients with type 2 diabetes (T2D). English language guidelines vary considerably with respect to recommended glycaemic targets, the selection of human vs analogue insulin, and choice of insulin regimen. Randomised trials directly comparing insulin initiation between basal and premixed analogues are scarce, and hard endpoint outcome data are inadequate. The evidence presented suggests that a major component of the HbA1c not being attained in every day clinical practice may be a result of factors that are not adequately addressed in forced titration trials of highly motivated patients, including failure to comply with complex treatment and monitoring regimens. Enforced intensification of unrealistic complex treatment regimens and glycaemic targets may theoretically worsen the psychological well-being in some patients. More simple and sustainable treatment regimens and guidelines are urgently needed. As for the use of insulin in T2D, there is limited evidence to convincingly support that initiation of insulin using basal insulin analogues is superior to initiation using premixed insulin analogues. While awaiting improved clinical efficacy and cost-effectiveness data, practical guidance from national and international diabetes organisations should consider more carefully the importance of: i) being clear and consistent; and ii) the early implementation of sustainable and cost-effective insulin treatment regimens with an emphasis on optimising treatment ease of use and patient compliance.

scholarly journals GOAL study: clinical and non-clinical predictive factors for achieving glycemic control in people with type 2 diabetes in real clinical practice

2018 ◽  
Vol 6 (1) ◽  
pp. e000519 ◽  
Author(s):  
Abdulqawi Al Mansari ◽  
Youssef Obeid ◽  
Najmul Islam ◽  
Mohammed Fariduddin ◽  
Ahmed Hassoun ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Predictive Factors ◽  
Fasting Blood Glucose ◽  
Diabetes Duration ◽  
Insulin Regimen ◽  
Premixed Insulin ◽  
Bolus Insulin ◽  
Insulin Glulisine

ObjectiveThe American Diabetes Association and the European Association for the Study of Diabetes guidelines recommend to individualize treatment targets/strategies in inadequately controlled patients by lifestyle management and glucose-lowering drugs to decrease the burden of diabetes-related complications. This real-world practice study aimed to assess predictive factors for achieving the glycemic hemoglobin A1c (HbA1c) at 6 months as targeted by the treating physician in adults with type 2 diabetes who required initiation of basal insulin, initiation of bolus insulin, or modification from basal or premixed insulin to new insulin regimen containing insulin glargine and/or insulin glulisine. Research design and methodsThis was an international, multicenter, observational survey with 12-month follow-up time in adults with type 2 diabetes inadequately controlled conducted in 10 developing countries. ResultsOverall, 2704 patients (mean age: 54.6 years, body mass index: 28.7 kg/m2; Caucasian: 46.1%, type 2 diabetes duration: 10.1 years) with poor glycemic control (mean HbA1c: 9.7% (83 mmol/mol), fasting blood glucose: 196.8 mg/dL) were eligible. At 6 months, advanced age, Caucasian ethnicity, shorter type 2 diabetes duration (>10 vs 1 year, p<0.0001), lower baseline HbA1c (≥ 8.5% vs <7%, p<0.0001) and no intake of oral antidiabetic drug (OAD) (none vs 2, p=0.02) were predictive factors for achieving glycemic goal as targeted by the treating physician. Absolute changes in the mean HbA1c of −1.7% and −2% were observed from baseline to 6 and 12 months, respectively. ConclusionsAlong with some well-known predictive factors, this study suggested that early insulin regimen treatment initiation and/or intensification allowed patients to promote glycemic control.

A cost comparison of a basal–bolus regimen (glargine and glulisine) with a premixed insulin regimen in type 2 diabetes patients: the GINGER study

2011 ◽  
Vol 11 (6) ◽  
pp. 314-318 ◽  
Author(s):  
Jiten P Vora ◽  
Yogesh S Punekar ◽  
Martin L Keech
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Aspart ◽  
Cost Comparison ◽  
Total Annual Cost ◽  
Insulin Regimen ◽  
Premixed Insulin ◽  
The Cost ◽  
Basal Bolus ◽  
Diabetes Patients

Objective To investigate the comparative costs of two different insulin regimens in type 2 diabetes based on data from the GINGER study, which investigated the efficacy and safety of an intensified insulin regimen. Methods GINGER (Glulisine in Combination with Insulin Glargine in an Intensified Insulin Regimen) was a 52-week open label multinational study in 310 type 2 diabetes patients (glycated haemoglobin A1C (HbA1C) 7.5–11.0%) treated with insulin ± metformin who were randomly allocated to a basal–bolus (glargine–glulisine) regimen or to continue with two injections per day of premixed insulin (neutral protamine hagedorn + regular insulin/insulin aspart). The cost analysis, comparing glargine–glulisine with biphasic insulin aspart (BIA) substituted for both premixes, was undertaken from a UK National Health Service perspective. Results The annual insulin cost per patient on glargine–glulisine (£691) was higher than BIA (£592). The cost of needles, lancets and test strips was lower for BIA than for glargine–glulisine due to fewer injections. The total annual cost per patient receiving glargine–glulisine was £1,244 compared with £939 for BIA. Over 52 weeks the relative cost of a 1% reduction in HbA1C was £950 for glargine–glulisine and £1,173 for BIA. Conclusion A similar reduction in HbA1C and fasting plasma glucose can be achieved at a relatively lower cost with glargine–glulisine compared with premixed insulins.

148-OR: IDegLira Improves Glycemic Control in Japanese Patients with Type 2 Diabetes (T2D) Uncontrolled on Premixed Insulin Therapy

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 148-OR ◽  
Author(s):  
HIROTAKA WATADA ◽  
BUE F. AGNER ◽  
ANKUR DOSHI ◽  
RANDI GRØN ◽  
MATTIS F. RANTHE ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Japanese Patients ◽  
Premixed Insulin
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