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What Is Basal And Prandial Insulin?

A Practical Approach For Implementation Of A Basal-prandial Insulin Therapy Regimen In Patients With Type 2 Diabetes

A Practical Approach For Implementation Of A Basal-prandial Insulin Therapy Regimen In Patients With Type 2 Diabetes

Go to: Basal-prandial insulin therapy is a physiologic approach to insulin delivery that utilizes multiple daily injections to cover both basal (ie, overnight fasting and between-meal) and prandial (ie, glucose excursions above basal at mealtime) insulin needs. While basal-prandial therapy with multiple daily injections is an important therapeutic option for patients with type 2 diabetes, there is a common perception that this therapy is difficult to initiate in the primary care setting. To address this issue, a panel of clinical experts convened to develop practical recommendations on how to initiate basal-prandial therapy in patients with type 2 diabetes, focusing on patient selection, simple dosing and titration, and monitoring. Patients with type 2 diabetes who are appropriate candidates for basal-prandial insulin therapy include those who: 1) are unable to achieve glycemic control on oral antidiabetic drugs, 2) are unable to achieve glycemic control on split-mixed/premixed insulin regimens, 3) are newly diagnosed but unlikely to respond to oral antidiabetic drugs alone (ie, the patient has severe hyperglycemia or a markedly elevated glycosylated hemoglobin A1C level for which oral antidiabetic drug therapy alone is unlikely to achieve goals), and 4) prefer this therapy due to socioeconomic or other individual considerations. Basal-prandial insulin can be initiated in a simple stepwise manner, starting first with the addition of basal insulin to the existing oral antidiabetic drug regimen, followed by the introduction of 1 prandial insulin injection to the basal insulin plus oral antidiabetic drug regimen (after basal insulin has been optimized). Subsequently, other injections of prandial insulin may be added when needed. Based on home glucose monitoring data, patie Continue reading >>

Injected Insulin

Injected Insulin

How it works: Insulin is a hormone produced by the pancreas that stimulates cells in the body to remove glucose from the blood for storage or usage. Normally, insulin is released when the body has high amounts of sugar in the blood, such as after a meal, to bring levels back into a normal range. Who uses it: People with type 1 diabetes and some people with type 2 diabetes use insulin. In-Depth Article: Insulins Unplugged – an overview of the different varieties of insulin available today. Other articles: FDA Approves New Insulin Glargine Basaglar - First "Biosimilar" Insulin in the US Basal vs. Prandial: Insulins can be divided into two categories based on function: basal (long-acting insulin) and prandial (rapid-acting or “mealtime” insulin). Basal insulin is designed to be injected once or twice daily to provide a constant level of insulin action throughout the day. Basal insulin helps keep blood sugars at a consistent level when you are not eating, but it is not enough to cover glucose spikes after mealtime. Prandial insulins, on the other hand, are taken at mealtime and act rapidly on the body, serving to bring down the high sugar levels following meals. Analog vs. Human Insulin: There are also two types of insulin structures: human insulin and analog insulin. Human insulins were developed first and are essentially identical in structure to the insulin produced in the body. Analog insulins are similar in structure but have minor biological modifications to give them desirable properties. While analog insulins cost more, they generally lead to less hypoglycemia and weight gain. Prandial insulin analogs tend to act faster than human insulin. Approved Insulins: Basal/Long-Acting: Analog Lantus and Toujeo (insulin glargine) Levemir (insulin detemir) Tresiba (insul Continue reading >>

Understanding Basal And Bolus Insulin

Understanding Basal And Bolus Insulin

The amount of bolus insulin produced depends on the size of the meal. In a person with type 1 diabetes , the pancreas no longer automatically makes insulin regardless of the intake of glucose. The beta cells that produce the insulin have largely shut down. Both the basal, or long-term background insulin, and the bolus, or quick bursts of insulin needed at mealtimes, must be obtained through injections or an insulin pump in order to process all of the glucose taken in through food or released by the liver. Long-acting basal insulins, such as NPH, Levemir, and Lantus, begin working in 1-2 hours but are released slowly so they can last up to 24 hours, providing that background insulin that is needed around the clock . Fast-acting bolus insulins, such as NovoLog, Apidra, Humalog, and Regular, generally begin working within 15 minutes. The exception is Regular, which has an onset of about 30 minutes. Each of these bolus insulins is designed to be taken just before a meal and have a duration of up to five hours for NovoLog, Apidra, and Humalog, and seven hours for Regular. This means that a person with type 1 diabetes would have to take multiple injections of a bolus insulin each day to cover their meals and snacks, along with a basal dose to keep the background insulin in check. Basal and Bolus Insulin With Insulin Pumps The person using an insulin pump would typically receive a constant low dose of fast-acting insulin that would act as the basal background insulin. Before meals, the pump user would give a larger dose of fast-acting insulin to cover the meal about to be eaten. This satisfies both the basal and bolus needs using the same fast-acting insulin. Whether injecting with a syringe or using an insulin pump, the actual dosing and type of insulin(s) used would be dete Continue reading >>

Evaluation Of Sliding-scale Insulin Versus Basal-prandial Insulin Use In Hospitalized Medicine Patients

Evaluation Of Sliding-scale Insulin Versus Basal-prandial Insulin Use In Hospitalized Medicine Patients

Evaluation of Sliding-Scale Insulin Versus Basal-Prandial Insulin Use in Hospitalized Medicine Patients This study was conducted to de This study was conducted to determine whether use of basal-prandial insulin (BPI) regimens provide better glycemic control than conventional treatment with sliding scale insulin (SSI) in non-critically ill medicine patients when used in practice at a large university affiliated hospital. A retrospective chart review was performed of randomly selected non-critically-ill medicine patients with type 1 or 2 diabetes that received treatment with either hospital protocol SSI or BPI therapy with glargine and aspart. A total of 90 patients were included in this study and divided into a SSI group ([italic]n[/italic] = 45) and a BPI group ([italic]n[/italic] = 45). Blood glucose (BG) readings were compared between the two groups to determine which had the highest percentage of BG readings within a predefined goal range of 70-180 mg/dL. Patients in the BPI group had an average of 23.6 BG readings with 53.8% (mean of 12.7) between 70-180 mg/dL. Patients in the SSI group had an average of 26.1 BG readings with 66.7% (mean of 17.4) between 70-180 mg/dL ([italic]p[/italic] = 0.07). Symptomatic hypoglycemia (BG [lt] 60 mg/dL) occurred in 0.5 (2.1%) of the BG readings in the BPI group and 0.3 (1.2%) in the SSI group ([italic]p[/italic] = 0.33). Hyperglycemia (BG [gt] 180 mg/dL) occurred in 9.6 (40.7%) of the BG readings in the BPI group and 8.2 (31.4%) in the SSI group ([italic]p[/italic] = 0.50).[br]Patients in this study showed no difference in glycemic control with the use of SSI compared to BPI therapy in the current practice model at this teaching institution. This finding is contradictory to previous studies comparing BPI with SSI and could be att Continue reading >>

Basal Insulin Types, Benefits, Dosage Information, And Side Effects

Basal Insulin Types, Benefits, Dosage Information, And Side Effects

The primary job of basal insulin is to keep your blood glucose levels stable during periods of fasting, such as while you’re sleeping. While fasting, your liver continuously secretes glucose into the bloodstream. Basal insulin keeps these glucose levels under control. Without this insulin, your glucose levels would rise at an alarming rate. Basal insulin ensures that your cells are fed with a constant stream of glucose to burn for energy throughout the day. Here’s what you need to know about basal insulin medication and why it’s important for managing diabetes. Types There are three main types of basal insulin. Intermediate-acting insulin, NPH Brand-name versions include Humulin and Novolin. This insulin is administered once or twice daily. It’s usually mixed with mealtime insulin in the morning, before your evening meal, or both. It works hardest in the 4 to 8 hours after injection, and the effects start waning after about 16 hours. Long-acting insulin Two types of this insulin currently on the market are detemir (Levemir) and glargine (Lantus). This basal insulin begins working 90 minutes to 4 hours after injection and remains in your bloodstream for up to 24 hours. It may start weakening a few hours earlier for some people or last a few hours longer for others. There isn’t a peak time for this type of insulin. It works at a steady rate throughout the day. Ultra-long acting insulin In January 2016, another basal insulin called degludec (Tresiba) was released. This basal insulin begins working within 30 to 90 minutes and remains in your bloodstream for up to 42 hours. As with the long-acting insulins detemir and glargine, there isn’t a peak time for this insulin. It works at a steady rate throughout the day. Insulin degludec is available in two strengths, 1 Continue reading >>

Efficacy Of Treatment With A Basal–prandial Insulin Regimen In Patients With Type 2 Diabetes Mellitus Previously Treated With Premixed Insulin

Efficacy Of Treatment With A Basal–prandial Insulin Regimen In Patients With Type 2 Diabetes Mellitus Previously Treated With Premixed Insulin

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

Basal Bolus - Basal Bolus Injection Regimen

Basal Bolus - Basal Bolus Injection Regimen

Tweet A basal-bolus injection regimen involves taking a number of injections through the day. A basal-bolus regimen, which includes an injection at each meal, attempts to roughly emulate how a non-diabetic person’s body delivers insulin. A basal-bolus regimen may be applicable to people with type 1 and type 2 diabetes. What is a basal-bolus insulin regimen? A basal-bolus routine involves taking a longer acting form of insulin to keep blood glucose levels stable through periods of fasting and separate injections of shorter acting insulin to prevent rises in blood glucose levels resulting from meals. What is basal insulin? The role of basal insulin, also known as background insulin, is to keep blood glucose levels at consistent levels during periods of fasting. When fasting, the body steadily releases glucose into the blood to our cells supplied with energy. Basal insulin is therefore needed to keep blood glucose levels under control, and to allow the cells to take in glucose for energy. Basal insulin is usually taken once or twice a day depending on the insulin. Basal insulin need to act over a relatively long period of time and therefore basal insulin will either be long acting insulin or intermediate insulin. What is bolus insulin? A bolus dose is insulin that is specifically taken at meal times to keep blood glucose levels under control following a meal. Bolus insulin needs to act quickly and so short acting insulin or rapid acting insulin will be used. Bolus insulin is often taken before meals but some people may be advised to take their insulin during or just after a meal if hypoglycemia needs to be prevented. Your doctor will be able to advise you if you have any questions as to when your bolus insulin should be taken. Advantages of a basal-bolus regimen One of t Continue reading >>

A Practical Guide To Basal And Prandial Insulin Therapy

A Practical Guide To Basal And Prandial Insulin Therapy

Diabetic patients with autonomic neuropathy often show delayed gastric emptying. Delayed emptying of gastric contents may lead to delayed postprandial increase of blood glucose level. In this study, we examined the relationship between gastric emptying time and postprandial insulin requirement (PIRR) as determined by artificial pancreas (Biostator) during feedback control of blood glucose level, and the possibility of improved blood glucose contorol by the recovery of gastric emptying time.Gastric emptying time was determined by 99mTC-Tin-colloid labeled scrambled egg meal served with 2 slices of toast and 200 ml of milk, (590 kcal). PIRR was calculated from infused insulin doses during a 2-hour period after the meal under the artificial pancreas.Patients without gastropathy had a PIRR of 11.75.3 units (MSD), whereas those with gastropathy had a PIRR of 5.62.1 units (during the 2-hour period after the meal, p<0.05). There was a highly negative correlation between the isotope remaining teh stomach and PIRR during the 2-hours after the meal (r=-0.84, p<0.005). Blood glucose control of diabetes was significantly improved by the recovery of gastric emptying time.Abnormal gastric emptying is an important factor in unstable diabetes mellitus. Normalization of gastric emptying time may be useful in blood glucose control. The UK Prospective Diabetes Study (UKPDS) is a multi-centre, prospective, randomised, intervention trial of 5100 newly-diagnosed patients with Type 2 (non-insulin-dependent) diabetes mellitus which aims to determine whether improved blood glucose control will prevent complications and reduce the associated morbidity and mortality. Newly presenting Type 2 diabetic patients aged 2565 years inclusive, median age 53 years, median body mass index 28 kg/m2 and medi Continue reading >>

Addition Of Biphasic, Prandial, Or Basal Insulin To Oral Therapy In Type 2 Diabetes

Addition Of Biphasic, Prandial, Or Basal Insulin To Oral Therapy In Type 2 Diabetes

Addition of Biphasic, Prandial, or Basal Insulin to Oral Therapy in Type 2 Diabetes Investigators in the Treating to Target in Type 2 Diabetes (4-T) study group are listed in the Appendix. Adding insulin to oral therapy in type 2 diabetes mellitus is customary when glycemic control is suboptimal, though evidence supporting specific insulin regimens is limited. In an open-label, controlled, multicenter trial, we randomly assigned 708 patients with a suboptimal glycated hemoglobin level (7.0 to 10.0%) who were receiving maximally tolerated doses of metformin and sulfonylurea to receive biphasic insulin aspart twice daily, prandial insulin aspart three times daily, or basal insulin detemir once daily (twice if required). Outcome measures at 1 year were the mean glycated hemoglobin level, the proportion of patients with a glycated hemoglobin level of 6.5% or less, the rate of hypoglycemia, and weight gain. At 1 year, mean glycated hemoglobin levels were similar in the biphasic group (7.3%) and the prandial group (7.2%) (P=0.08) but higher in the basal group (7.6%, P<0.001 for both comparisons). The respective proportions of patients with a glycated hemoglobin level of 6.5% or less were 17.0%, 23.9%, and 8.1%; respective mean numbers of hypoglycemic events per patient per year were 5.7, 12.0, and 2.3; and respective mean weight gains were 4.7 kg, 5.7 kg, and 1.9 kg. Rates of adverse events were similar among the three groups. A single analogue-insulin formulation added to metformin and sulfonylurea resulted in a glycated hemoglobin level of 6.5% or less in a minority of patients at 1 year. The addition of biphasic or prandial insulin aspart reduced levels more than the addition of basal insulin detemir but was associated with greater risks of hypoglycemia and weight gain. ( Continue reading >>

A Practical Guide To Basal And Prandial Insulin Therapy.

A Practical Guide To Basal And Prandial Insulin Therapy.

A practical guide to basal and prandial insulin therapy. Separating basal and meal-related insulin requirements allows a systematic approach to subcutaneous insulin therapy. Simple guidelines for both the doctor and patient can cater for the spectrum of severity of diabetes. A non-insulin-dependent diabetic who, despite dieting, continues to have moderate fasting hyperglycaemia (6-10 mmol/l) may need only a basal insulin supplement, whereas a totally insulin-dependent diabetic usually needs similar amounts of basal and meal-related insulin. The likely insulin requirements of individual diabetics can be predicted, including the increased amounts required by obese patients. The algorithms have been developed using ultralente to provide the basal insulin requirement, but the principles and doses probably apply to other similarly long-acting insulins or an insulin pump. The insulin doses can be easily altered for varying lifestyles, including night work, religious fasts or long distance aeroplane travel, and for temporary disturbances such as operations or intercurrent infections. Continue reading >>

Using Prandial Insulin To Achieve Glycemic Control In Type 2 Diabetes

Using Prandial Insulin To Achieve Glycemic Control In Type 2 Diabetes

Using prandial insulin to achieve glycemic control in type 2 diabetes J Fam Pract. 2007 September;56(9):735-741 Dr Dailey has been on the speakers bureau for Amylin Pharmaceuticals, Inc; Bristol-Myers Squibb Company; Eli Lilly and Company; GlaxoSmithKline; Merck & Co, Inc; Merck KGaA; Novartis Pharmaceuticals Corporation; Pfizer Inc; and Sanofi-Aventis US. He also has been an investigator for Amylin Pharmaceuticals, Inc; Becton, Dickinson and Company; Bristol-Myers Squibb Company; Eli Lilly and Company; Forest Pharmaceuticals, Inc; GlaxoSmithKline; Merck & Co, Inc; Novartis Pharmaceuticals Corporation; Novo Nordisk Pharmaceuticals, Inc; Pfizer Inc; Pharmacia; Roche; Sanofi-Aventis US; Schering-Plough; and Takeda Pharmaceuticals North America, Inc. Dr Dailey is also an occasional consultant for Amylin Pharmaceuticals, Inc; Bristol-Myers Squibb Company; Eli Lilly and Company; GlaxoSmithKline; Merck & Co, Inc; Novo Nordisk Pharmaceuticals, Inc; Pfizer Inc; and Sanofi-Aventis US. A stepped approach to postprandial hyperglycemiaincluding prandial insulinis key. 1. Bonora E, Corrao G, Bagnardi V, et al. Prevalence and correlates of post-prandial hyperglycaemia in a large sample of patients with type 2 diabetes mellitus. Diabetologia 2006;49:846-854. 2. Tominaga M, Eguchi H, Manaka H, Igarashi K, Kato T, Sekikawa A. Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes Study. Diabetes Care 1999;22:920-924. 3. The DECODE study group on behalf of the European Diabetes Epidemiology Group. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. Lancet 1999;354:617-621. 4. Decode Study Group. Is the current definition for diabetes relevant to mortality risk f Continue reading >>

Management Of Type 2 Diabetes Methods For Addition Of Prandial To Basal Insulin

Management Of Type 2 Diabetes Methods For Addition Of Prandial To Basal Insulin

Management of Type 2 Diabetes Methods for Addition of Prandial to Basal Insulin European Endocrinology, 2014;10(2):12430 DOI: As glycaemic control deteriorates with the progression of type 2 diabetes, treatment guidelines advocate starting basal insulin therapy, andthen progressing to a basalbolus regimen as needed. Nevertheless, although timely intensification of therapy is important to minimise therisk of diabetic complications, considerable clinical inertia exists, not only in the initiation of insulin but also in the progression to multiple-doseinsulin regimens. One barrier has been the lack of guidance about how to make the transition from basal-only to basalbolus insulin therapy.In this review, we discuss how data from the recent FullSTEP study, along with other randomised studies, will help to bridge this gap. Prandialboluses can be added to basal insulin in a stepwise manner, using a straightforward, patient-led dose titration approach and simple estimationof which meal to add the initial prandial bolus to. Reducing the complexity of progression to multiple-dose insulin regimens and empoweringpatients will lessen the burden on clinicians, improve treatment satisfaction and facilitate timely implementation of treatment guidelines. Keywords: Type 2 diabetes, stepwise, basal Disclosure: Helena W Rodbard has served as a principal investigator in clinical trials sponsored by Novo Nordisk, has served as a consultant on advisory panels and as a speaker for Novo Nordisk and has served in similar capacities for several pharmaceutical companies that have or are developing various forms of insulin therapy. Boris Karolicki is employed by Novo Nordisk Inc. as a Medical Director for modern insulins and insulin-delivery devices. Acknowledgments: The FullSTEP trial was sponsor Continue reading >>

Insulin Management Of Type 2 Diabetes Mellitus

Insulin Management Of Type 2 Diabetes Mellitus

Insulin therapy is recommended for patients with type 2 diabetes mellitus and an initial A1C level greater than 9 percent, or if diabetes is uncontrolled despite optimal oral glycemic therapy. Insulin therapy may be initiated as augmentation, starting at 0.3 unit per kg, or as replacement, starting at 0.6 to 1.0 unit per kg. When using replacement therapy, 50 percent of the total daily insulin dose is given as basal, and 50 percent as bolus, divided up before breakfast, lunch, and dinner. Augmentation therapy can include basal or bolus insulin. Replacement therapy includes basal-bolus insulin and correction or premixed insulin. Glucose control, adverse effects, cost, adherence, and quality of life need to be considered when choosing therapy. Metformin should be continued if possible because it is proven to reduce all-cause mortality and cardiovascular events in overweight patients with diabetes. In a study comparing premixed, bolus, and basal insulin, hypoglycemia was more common with premixed and bolus insulin, and weight gain was more common with bolus insulin. Titration of insulin over time is critical to improving glycemic control and preventing diabetes-related complications. Insulin is secreted continuously by beta cells in a glucose-dependent manner throughout the day. It is also secreted in response to oral carbohydrate loads, including a large first-phase insulin release that suppresses hepatic glucose production followed by a slower second-phase insulin release that covers ingested carbohydrates 1 (Figure 12). Clinical recommendation Evidence rating References Analogue insulin is as effective as human insulin but is associated with less postprandial hyperglycemia and delayed hypoglycemia. A 17–19 Fasting glucose readings should be used to titrate basal insul Continue reading >>

Potential Advantages Of A Basalbolus Regimen Using Insulin Glulisine As Prandial Insulin

Potential Advantages Of A Basalbolus Regimen Using Insulin Glulisine As Prandial Insulin

Potential Advantages of a BasalBolus Regimen Using Insulin Glulisine as Prandial Insulin Several interventional studies have demonstrated that achieving near-normal glycaemic control by means of intensive insulin therapy is the best strategy to avoid and slow the progression of chronic complications in type 1 and type 2 diabetes.13 Interestingly, the benefits of intensive treatment seem to extend over time, at least in people with type 1 diabetes, as shown in the Epidemiology of Diabetes and Interventions and Complications (EDIC) trial.4 However, intensive insulin therapy using multiple daily injections (MDIs) or continuous subcutaneous insulin infusion (CSII) increased the risk of severe hypoglycaemia about three-fold.1 One of the probable explanations behind this observation was the use of unphysiological insulin formulations, because both regular human insulin (RHI) and isophane insulin (NPH) are far from ideal as insulin replacements. In the last 15 years, new insulin formulations have been coming into the market. First, short-acting insulin analogues (SAIAs) were developed to reproduce the physiological prandial insulin response, which is rapid, powerful and of short duration.5 More recently, long-acting insulin analogues (LAIAs) were introduced to replace basal insulin secretion, which is peakless, sustained and necessary to avoid excessive hepatic glucose production.5 Insulin glulisine is the most recently marketed SAIA beside insulin lispro and insulin aspart and is available to be used as prandial insulin in adults with type 1 and type 2 diabetes. In this article, the potential advantages of insulin glulisine will be discussed, as well as its role as prandial insulin in a basalbolus regimen. The SAIA glulisine (rDNA origin, Sanofi-Aventis, Inc.) is produced by Continue reading >>

Basal, Prandial Insulin Added To Oral Therapy Produced Greater Glycemic Control Than Biphasic Insulin Regimen

Basal, Prandial Insulin Added To Oral Therapy Produced Greater Glycemic Control Than Biphasic Insulin Regimen

Basal, prandial insulin added to oral therapy produced greater glycemic control than biphasic insulin regimen Three-year data support the addition of basal or prandial insulin to oral therapy compared with a biphasic insulin-based regimen in patients with type 2 diabetes. Please provide your email address to receive an email when new articles are posted on this topic. Receive an email when new articles are posted on this topic. New data from the Treating-to-Target in Type 2 Diabetes (4-T) trial reveal that the addition of basal or prandial insulin to oral therapy was associated with better HbA1c control, fewer hypoglycemic events and less weight than the addition of biphasic insulin. Our results show that using a basal insulin first, then adding prandial insulin as needed, can achieve guideline HbA1c levels with only a modest risk for hypoglycemia or weight gain, Rury Holman, MD, professor of diabetic medicine and director of the Diabetes Trials Unit at University of Oxford, told Holman and colleagues randomly assigned 235 patients to receive twice-daily biphasic insulin aspart (NovoMix 30, Novo Nordisk), 239 patients to three times-daily prandial insulin aspart (NovoRapid, Novo Nordisk) and 234 patients to once-daily (twice if required) basal insulin detemir (Levemir, Novo Nordisk). All patients had suboptimal HbA1c levels while on metformin and sulfonylurea therapy. Sulfonylurea therapy was replaced by a second type of insulin if hyperglycemia became unacceptable during the first year of the study or if HbA1c levels were >6.5%. Holman reported the results of 4-T at a late-breaking clinical trials session at the 20th World Congress of Diabetes, and the data were published simultaneously on Median HbA1c levels were similar for patients assigned to the biphasic insulin- Continue reading >>

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