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Adding Single Insulin to Oral Meds Fails Most Diabetics

Basal insulin carries lower risk of weight gain and hypoglycemic events

THURSDAY, Sept. 27 (HealthDay News) -- Only a minority of diabetic patients with suboptimal glycemic control on oral drugs achieve target glycated hemoglobin levels with the addition of a single type of insulin, according to a study published online Sept. 21 in the New England Journal of Medicine. Basal insulin was slightly less effective than regimens with short-acting insulin, but was associated with a lower risk of weight gain and hypoglycemic events.

Rury R. Holman, from Churchill Hospital in Oxford, United Kingdom, and colleagues studied 708 patients with type 2 diabetes whose glycated hemoglobin levels were 7 percent to 10 percent, and who were taking the maximum tolerated dose of metformin and sulfonylurea. Patients were randomly assigned to biphasic insulin aspart twice a day, prandial insulin aspart three times a day, or basal insulin detemir once or twice a day.

The researchers found that glycated hemoglobin levels were reduced to 6.5 percent or less in 17 percent of the biphasic group, 23.9 percent of the prandial group, and 8.1 percent of the basal group. However, the mean numbers of hypoglycemic events per patient per year were 5.7, 12.0, and 2.3, respectively, and the mean weight gains were 4.7 kg, 5.7 kg, and 1.9 kg, respectively.

"This finding, the lower rates of hypoglycemia, reduced weight gain, simplicity, and convenience might be taken to support basal insulin as a first-line add-on to dual therapy with oral antidiabetic agents in some patients. However, rapid intensification of therapy will be necessary for many of them," the authors conclude.

The study was partially supported by Novo Nordisk.

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