Study Examines Adding Insulin to Oral Antidiabetic Therapy
Findings support basal insulin regimen addition to oral therapy versus biphasic regimen
THURSDAY, Oct. 22 (HealthDay News) -- Type 2 diabetics on oral therapy appear to benefit most from the addition of basal insulin-based therapy, as compared to a prandial or biphasic insulin-based program, according to research published online Oct. 22 in the New England Journal of Medicine.
Rury R. Holman, of the University of Oxford in the United Kingdom, and colleagues analyzed data from 708 patients using metformin and sulfonylurea therapy, but with less than optimal levels of glycated hemoglobin. Patients were randomized to receive biphasic insulin aspart, prandial insulin aspart, or basal insulin detemir, with a second type of insulin replacing the sulfonylurea if needed for hyperglycemia in the first year or glycated hemoglobin above 6.5 percent afterward.
The researchers found that the groups achieved similar levels of median glycated hemoglobin (6.8 to 7.1 percent). However, fewer in the biphasic group than the prandial or basal group hit the glycated hemoglobin target of 6.5 percent or less (31.9 versus 44.7 and 43.2 percent, respectively). Those receiving prandial insulin had the most hypoglycemic episodes and the highest mean weight gain of the three groups. Patients receiving basal insulin had fewer hypoglycemic episodes and less weight gain.
"Can the three-year results obtained by Holman et al be extended to clinical practice in treating patients with type 2 diabetes? The treatment algorithms for adding insulin to metformin and sulfonylurea seem relatively simple, safe, and convenient in outpatients. However, this study used only insulin analogues (which were produced by only one company), whereas regular human insulin is considered the first choice in consensus statements," writes the author of an accompanying editorial.
The study was supported by Novo Nordisk and Diabetes U.K. Several co-authors and the editorial author reported financial relationships with a variety of companies.