Effects of switching from prandial premixed insulin therapy to basal plus two times bolus insulin therapy on glycemic control and quality of life in patients with type 2 diabetes mellitus

Abstract

BackgroundThe effects of switching from prandial premixed insulin therapy (PPT) injected three times a day to basal plus two times bolus insulin therapy (B2B) on glycemic control and quality of life were investigated in patients with type 2 diabetes mellitus.MethodsThe clinical course was prospectively observed during the first 16 weeks after switching to B2B (insulin glargine plus insulin glulisine before breakfast and dinner) in 27 subjects previously treated with PPT using 50/50 premixed insulin. The Diabetes Treatment Satisfaction Questionnaire (DTSQ) was administered at the start and end of the study.ResultsThe glycated hemoglobin (HbA1c) level (8.3%±1.8% to 8.2%±1.1%) and the DTSQ score did not change between the start and end of the study. An improvement in HbA1c level was found in nine (33%) subjects. The change in HbA1c showed a significant negative correlation with baseline HbA1c, and was significantly better in patients with a baseline HbA1c >8.0% than in those with an HbA1c ≤8.0% (−0.9±2.0 versus 0.3±0.6, respectively, P=0.02). The change in DTSQ score representing treatment satisfaction was significantly greater in patients whose HbA1c level was improved than in those in whom it was not (2.7±3.6 versus −0.8±3.5, P=0.04).ConclusionB2B was noninferior to PPT with regard to HbA1c levels in patients with type 2 diabetes mellitus. B2B should be considered particularly for subjects whose glycemic control is poor despite PPT.

Use of 50/50 Premixed Insulin Analogs in Type 2 Diabetes: Systematic Review and Clinical Recommendations

“…Nine studies examined Mix50 for insulin initiation [ 14 , 16 , 18 – 20 , 22 , 29 , 31 , 32 ] (Table 1 ), and 13 studies examined Mix50 for intensification [ 15 , 17 , 21 , 23 – 27 , 34 , 36 , 40 – 42 ] (Table 2 ). The remaining 13 studies were not included in these sets for reasons such as combining initiation and intensification or not comparing Mix50 with other insulins [ 9 , 12 , 13 , 28 , 30 , 33 , 35 , 37 – 39 , 43 – 45 ] (Table 3 ).…”

“…The other RCTs were conducted in Asia (China, Taiwan, Korea) [ 21 ] and in the United States and Puerto Rico [ 27 ]. An additional 16-week nonrandomized study conducted in Japan examined 28 patients who switched from Mix50 to basal insulin glargine plus insulin glulisine BID [ 36 ].…”

“…In the RCTs, Lispro 50 reduced HbA1c to a similar [ 21 , 23 ] or lesser [ 27 ] extent than basal–bolus insulin (Table 2 ). In the nonrandomized study, switching from Mix50 to basal–bolus resulted in a nonsignificant decrease in HbA1c (− 0.1%) [ 36 ] (Table 2 ). The mean change from baseline in HbA1c with Lispro 50 was − 1.1% [ 21 ] and − 1.87% [ 27 ] in the two RCTs that reported this variable.…”

Evaluation of a Premixed Insulin Analog Suspension in Japanese People with Type 2 Diabetes and the Clinical Importance of Improved Injection Techniques: A Cross-Sectional Pilot Study

“…According to the consensus algorithm for patients with type 2 diabetes from ADA/EASD2015, premixed insulin is considered moderately complex but not very flexible [9], whereas basal-bolus therapy is recommended because it is more flexible than other regimens. Although guidelines do not strongly recommend this practice, premixed insulin can be adopted after considering a patient’s condition, lifestyle, and situation, especially in Japan [10]. Although we did not investigate a correlation between improved HbA1c levels and insulin injection techniques, physicians and patients must be educated about the proper method for resuspending premixed insulin in order to improve diabetes control and ensure safety.…”

Number-Based Approach to Insulin Taxonomy

“…T2DM ( n = 588) [ 48 ] Ito et al Drug Des Devel Ther 2014. T2DM ( n = 27) [ 49 ] Urata et al J Ren Nutr 2015. T2DM ( n = 18) [ 50 ] Choe et al Diabetes Metab J 2012.…”