Efficacy of treatment with a basal–prandial insulin regimen in patients with type 2 diabetes mellitus previously treated with premixed insulin

Abstract

Introduction

Premixed insulins are a common treatment for type 2 diabetes mellitus (DM). However, their limitations and the lack of achieving glycaemic control in some patients reinforce the need to find therapeutic alternatives.

Objectives

To assess whether basal–prandial therapy (basal insulin, and additional pre-prandial rapid insulin boluses, when required) improves glycaemic control in patients with type 2 DM and glycosylated haemoglobin (HbA1c) >53 mmol/mol (7%) treated with premixed insulin in the primary care setting.

Material and methods

A retrospective observational study in which 116 patients with type 2 DM switched from premixed insulin to basal–prandial therapy. Data on demographics, anthropometrics, laboratory results, and antidiabetic treatment were collected from the medical charts of the patients, prior to switching the treatment (baseline) and 4 months thereafter.

Results

HbA1c significantly decreased from baseline to month 4 (65.1 ± 5.7 mmol/mol [8.1 ± 0.5%] versus 51.9 ± 7.2 mmol/mol [6.9 ± 0.7%]; p < .005), and 70 patients (60.9%) had an HbA1c ≤53 mmol/mol (7%). Additionally, fasting blood glucose (FBG) significantly decreased (9.7 ± 1.7 mmol/l [175.4 ± 31.2 mg/dl] versus 6.9 ± 1.4 mmol/l [124.4 ± 25.8 mg/dl]; p < .005), and the number of patients with FBG < 5.6 mmol/l (100 mg/dl) (2 patients [1.7%] versus 21 patients [18.3%]; p < .005), and with post-prandial blood glucose ≤10 mmol/l (180 mg/dl) (14 patients, [12.1%] versus 87 patients [76.3%]; p < .05) significantly increased. There were also significant decreases in body weight (76.3 ± 12.9 kg versus 74.8 ± 12.5 kg; p < .001) and waist circumference (96.1 ± 16.0 cm versus 94.4 ± 14.5 cm; p < .005). Only 4 patients (3.5%) had hypoglycaemia.

Conclusions

Basal–prandial therapy improved glycaemic control in patients with type 2 DM, with a low incidence of hypoglycaemia, and decreased body weight.