| Starting insulin therapy with basal insulin analog or premix insulin analog in T2DM: a pooled analysis of treat-to-target trials. | |
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MedLine Citation:
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PMID: 20429817 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Although the choice of starting insulin for people with type 2 diabetes mellitus (T2DM) is often a basal or premix insulin analog, there is little evidence to base this decision on. This analysis aimed to determine if measurable clinical characteristics prior to starting insulin could predict differences in improved glycemic control between these options. RESEARCH DESIGN AND METHODS: A thorough literature search was performed for treat-to-target studies in insulin-naïve individuals with T2DM treated with biphasic insulin aspart (BIAsp 30), a basal insulin analog (insulin glargine or insulin detemir) or NPH insulin regimens once or twice daily plus oral glucose-lowering drugs (OGLDs). Patient data were pooled and mean baseline age, diabetes duration, gender, body mass index (BMI), HbA(1c), fasting plasma glucose (FPG), average postprandial plasma glucose over three meals (PPG) and bedtime PG were investigated for prediction of improved HbA(1c), FPG or PPG. Statistical analyses employed a linear mixed model with insulin type, OGLD, time and time-squared as fixed effects and patient and trial as random effects. RESULTS: Baseline age (p = 0.022) and bedtime PG (p = 0.036) were inter-related predictors of HbA(1c). In older individuals with higher bedtime PG, BIAsp 30 appeared to be more beneficial. In contrast, basal insulin appeared to be a better choice in younger individuals with lower bedtime PG. For FPG, BMI (p = 0.011) and post-breakfast PG (p = 0.042) were identified as predictors. Basal insulin appeared to achieve better FPG in patients with lower BMI and higher post-breakfast PG, while BIAsp 30 appeared to be better in patients with higher BMI and lower post-breakfast PG. Age (p = 0.0347) was the only baseline characteristic associated with differences in average PPG: mean PPG was similar between regimens in younger people, but BIAsp 30 achieved better PPG results in older persons. Minor hypoglycemia was reported by 56% of BIAsp 30- and 45% of basal-treated individuals. The major limitation of the study was that only Novo Nordisk trials were included in the analysis as access to individual patient data was required. As the trials were fairly heterogeneous a strict methodology was used to minimize potential confounding factors. CONCLUSIONS: Premix analog rather than basal insulin may be an appropriate choice to target HbA(1c) values in older individuals and those with higher bedtime PG, while basal insulin may be more appropriate to target FPG in patients with lower BMI and higher post-breakfast PG. |
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Authors:
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Vivian Fonseca; Jaime Davidson; Philip Home; James Snyder; Paul Jellinger; Anders Dyhr Toft; Anthony Barnett |
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Publication Detail:
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Type: Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Current medical research and opinion Volume: 26 ISSN: 1473-4877 ISO Abbreviation: Curr Med Res Opin Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-06-15 Completed Date: 2010-09-28 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0351014 Medline TA: Curr Med Res Opin Country: England |
Other Details:
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Languages: eng Pagination: 1621-8 Citation Subset: IM |
Affiliation:
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Tulane University Health Sciences Center, New Orleans, LA 70112, USA. vfonseca@tulane.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Blood Glucose / analysis Clinical Trials as Topic / methods* Diabetes Mellitus, Type 2 / blood, drug therapy* Dosage Forms Drug Administration Schedule Drug Combinations Drug Delivery Systems / methods Female Hemoglobin A, Glycosylated / analysis Humans Hypoglycemia / blood, epidemiology, etiology Hypoglycemic Agents / administration & dosage Insulin / administration & dosage*, analogs & derivatives* Male Middle Aged Postprandial Period Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Blood Glucose; 0/Dosage Forms; 0/Drug Combinations; 0/Hemoglobin A, Glycosylated; 0/Hypoglycemic Agents; 11061-68-0/Insulin |
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