Glycemic Control Suboptimal with a Single Insulin Type

Trial compares short-acting and basal insulins added to oral therapy in individuals with type 2 diabetes

WEDNESDAY, Oct. 24 (HealthDay News) -- Adding a single analogue-insulin formulation to the treatment of individuals with diabetes who are failing oral therapy leads to target glycemic control in a minority of individuals, according to a report published in the Oct. 25 issue of the New England Journal of Medicine.

As part of the Treating to Target in Type 2 Diabetes (4-T) study, Rury R. Holman, of the University of Oxford in the United Kingdom, and colleagues randomized 708 patients with suboptimally controlled type 2 diabetes on maximally tolerated doses of metformin and sulfonylurea to receive biphasic insulin aspart twice daily, insulin aspart three times daily with meals, or basal insulin detemir once daily (or twice daily if needed).

After one year, the biphasic and prandial aspart insulin groups achieved similar glycated hemoglobin levels (7.3 percent and 7.2 percent, respectively), but individuals in the basal insulin group had significantly higher values (7.6 percent). The proportion of patients achieving glycated hemoglobin levels of 6.5 percent or less in the biphasic, prandial and basal insulin groups were 17 percent, 23.9 percent and 8.1 percent, respectively.

"The first phase of the 4-T study, which compared three alternative analogue-insulin initiation therapies, suggests that most patients are likely to need more than one type of insulin to achieve target glucose levels. The final two years of the trial will examine specifically the use of complex insulin regimens in these patients," the authors write.

This research was partially funded by Novo Nordisk.

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