Adjust to Target in Type 2 Diabetes

Abstract

OBJECTIVE -Carbohydrate counting is an effective approach to mealtime insulin adjustment in type 1 diabetes but has not been rigorously assessed in type 2 diabetes. We sought to compare an insulin-to-carbohydrate ratio with a simple algorithm for adjusting the dose of prandial insulin glusiline.RESEARCH AND DESIGN METHODS -This 24-week, multicenter, randomized, controlled study compared two algorithms for adjusting mealtime (glulisine) insulin along with a standard algorithm for adjusting background (glargine) insulin in 273 intent-to-treat patients with type 2 diabetes. Glulisine and glargine were adjusted weekly in both groups based on self-monitored blood glucose (SMBG) results from the previous week. The simple algorithm group was provided set doses of glulisine to take before each meal. The carbohydrate counting (carb count) group was provided an insulin-to-carbohydrate ratio to use for each meal and adjusted their glulisine dose based on the amount of carbohydrate consumed.RESULTS -A1C levels at week 24 were 6.70% (simple algorithm) and 6.54% (carb count). The respective mean A1C changes from baseline to 24 weeks were Ϫ1.46 and Ϫ1.59% (P ϭ 0.24). A1C Ͻ7.0% was achieved by 73.2% (simple algorithm) and 69.2% (carb count) (P ϭ 0.70) of subjects; respective values for A1C Ͻ6.5% were 44.3 and 49.5% (P ϭ 0.28). The total daily dose of insulin was lower, and there was a trend toward less weight gain in carb count group patients. Severe hypoglycemia rates were low and equal in the two groups.CONCLUSIONS -Weekly basal-bolus insulin adjustments based on premeal and bedtime glucose patterns resulted in significant reductions in A1C. Having two effective approaches to delivering and adjusting rapid-acting mealtime insulin may increase physicians' and patients' willingness to advance therapy to a basal-bolus insulin regimen.

Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

“…Accordingly, the more complex and intensive strategies of type 1 diabetes are not typically necessary. 72 Ideally, the principle of insulin use is the creation of as normal a glycemic profile as possible without unacceptable weight gain or hypoglycemia. 73 As initial therapy, unless the patient is markedly hyperglycemic and/or symptomatic, a "basal" insulin alone is typically added.…”

Hypoglycemia in patients with insulin‑treated diabetes

“…95 This study showed that the therapy with the threshold suspend feature reduced noc turnal hypoglycemia without increasing HbA 1c values.…”

“…95 This study showed that the therapy with the threshold suspend feature reduced noc turnal hypoglycemia without increasing HbA 1c values. 95 The first step in developing an artificial pancreas is a quite recent advance in insulin treat ment technology, which is a sensor augmented insulin pump with automatic low glucose sus pension of the basal rate of the insulin for up to 2 hours once the interstitial glucose concentration reaches a preset threshold. This innovation is es pecially important for people who sleep through alarms, because it can potentially reduce severe hypoglycemic episodes at night.…”

“…77,78 Typically, in this type of disease, basal insulin alone is added as an initial insulin regimen. 79 This therapy covers insulin needed throughout the day and night and lowers blood glucose levels mainly due to suppression of inter prandial and night hepatic glucose production.…”

An Analysis of Data Management Tools for Diabetes Self-Management: Can Smart Phone Technology Keep Up?

“…Effective patient blood glucose self-monitoring remains a crucial component of diabetes management. Patient monitoring, particularly among patients on insulin, 11,12 is important in limiting disease progression, but can be labor-intensive, costly, and cumbersome to share with health care providers (HCPs). 9,10 Over the past several decades, health technologies have successfully aided patients in diabetes self-management, e.g., blood glucose monitoring.…”